CMS Pub. 100-04, ch. 18, § 170.3

Effective for dates of service November 8, 2011, and later, A/B MACs (A) and (B) shall

recognize HCPCS code G0445 for HIBC. Medicare shall cover up to two occurrences of G0445

when billed for HIBC to prevent STIs. A claim that is submitted with HCPCS code G0445 for

HIBC shall be submitted with ICD-10-CM diagnosis code Z72.89.

A/B MACs (A) and (B) shall pay for screening for chlamydia, gonorrhea, and syphilis (as

indicated by the presence of ICD-10 is applicable, ICD-10-CM diagnosis code Z11.3; and/or

hepatitis B (as indicated by the presence of ICD-10-CM diagnosis code Z11.59 as follows:

• One annual occurrence of screening for chlamydia, gonorrhea, and syphilis (i.e., 1 per 12-month period) in women at increased risk who are not pregnant,

• One annual occurrence of screening for syphilis (i.e., 1 per 12-month period) in men at

increased risk,

• Up to two occurrences per pregnancy of screening for chlamydia and gonorrhea in pregnant

women who are at increased risk for STIs and continued increased risk for the second

screening,

• One occurrence per pregnancy of screening for syphilis in pregnant women,

• Up to an additional two occurrences per pregnancy of screening for syphilis in pregnant

women if the beneficiary is at continued increased risk for STIs,

• One occurrence per pregnancy of screening for hepatitis B in pregnant women, and,

• One additional occurrence per pregnancy of screening for hepatitis B in pregnant women who

are at continued increased risk for STIs.