Medicare Will Cover Hepatitis C Screening in Primary Care Settings

On June 2, 2014, the Centers for Medicare & Medicaid Services (CMS) announced its determination that hepatitis C virus (HCV) screening will be covered by Medicare for adults in primary care. Specifically, the determination stated that CMS will cover HCV screening when ordered by a beneficiary's primary care physician or practitioner within the context of a primary care setting, and performed by an eligible Medicare provider, for beneficiaries who meet either of the following conditions:

1. A screening test is covered for adults at high risk for Hepatitis C Virus infection. “High risk” is defined as persons with a current or past history of illicit injection drug use; and persons who have a history of receiving a blood transfusion prior to 1992. Repeat screening for high risk persons is covered annually only for persons who have had continued illicit injection drug use since the prior negative screening test.
2. A single screening test is covered for adults who do not meet the high risk as defined above, but who were born from 1945 through 1965.

In its National Coverage Determination, CMS observed that “the evidence is adequate to conclude that screening for Hepatitis C Virus (HCV), consistent with the grade B recommendations by the U.S. Preventive Services Task ForceExit Disclaimer (USPSTF), is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.” Read the full decision memo on the CMS website.

“This significant development will aid in nationwide efforts to improve hepatitis diagnosis, care, and treatment detailed in the updated Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (2014-2016),” observed Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases. “We encourage all stakeholders to join in raising awareness about the CMS decision among both healthcare providers and Medicare beneficiaries who may benefit from an HCV screening, particularly those born between 1945 and 1965 who comprise more than 75 percent of people with Hepatitis C in the United States.”