US · guidance
NCD 190.9
Serologic Testing for Acquired Immunodeficiency Syndrome (AIDS)
Item/Service Description
Serologic testing is employed to detect antibodies to the AIDS virus, which is currently identified by the term "human immunodeficiency virus (HIV)." The virus originally was named "human T-cell lymphotropic virus, type III (HTLV-III), a term that remains in common usage.
Antibodies may be detected by a variety of immunoassay techniques, the most common being an enzyme linked immunosorbent assay (ELISA). When an assay is reactive on initial testing, it should be repeated on the same specimen. A more specific test, (Western blot, immunofluorescent assay) is usually performed following repeatedly reactive ELISA results.
Indications and Limitations of Coverage
These tests may be covered when performed to help determine a diagnosis for symptomatic patients. They are not covered when furnished as part of a screening program for asymptomatic persons.
NOTE: Two enzyme-linked immunosorbent assay (ELISA) tests that were conducted on the same specimen must both be positive before Medicare will cover the Western blot test.
Revision History
07/1987 - Provided coverage when needed to help determine a diagnosis for symptomatic patients and coverage when furnished as part of a screening program for asymptomatic people. Effective date 08/12/1987. (TN 17)
History
Version 1
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-26
- Edition
- mcd-2026-08-26
- Content hash
05d51c96d25093355eec9fe87061692b6a82ade623f56807be014b80e4bcd86b
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