Prior Authorization Review

Panel MCO Policy Submission

A separate copy of this form must accompany each policy submitted for
review.
Policies submitted without this form will not be considered for review.

Plan: Aetna Better Health Submission Date: 11/01/2018

Policy Number: 0835 Effective Date:

Revision Date:
Policy Name: Hepatitis Screening

Type of Submission – Check all that apply:

New Policy
Revised Policy*
Annual Review – No Revisions
*All revisions to the policy must be highlighted using track changes throughout the
document. Please provide any clarifying information for the policy below:

CPB 0835 Hepatitis Screening

Clinical content was last revised 12/09/2016. Additional non-clinical updates were made by
Corporate since the last PARP submission, as documented below.

Revision and Update History since last PARP submission:

12/06/2017 - This CPB has been updated with additional references.
09/27/2018 – Next tentative scheduled review date by Corporate
.

Name of Authorized Individual (Please type or print): Signature of Authorized Individual:

Dr. Bernard Lewin, M.D.

www.aetnabetterhealth.com/pennsylvania Updated 12/06/2017

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Hepatitis Screening

Number: 0835
*Please see amendment for Pennsylvania Medicaid at the end of this CPB.

Policy His tory

Policy
Aetna considers hepatitis B virus (HBV) screening medically Last Review

necessary for the following individuals: 12/06/2017

Effective: 12/07/2012

▪ Current or former hemodialysis individuals Next

▪ Donors of blood, plasma, organs, tissues, or semen Review: 09/27/2018

▪ Household, needle-sharing, or sexual contacts of

Review History
persons known to be HBV-positive
▪ Individuals born in Asia, Africa, and other geographic
regions with a 2 % or higher prevalence of chronic HBV
Definitions
infection
▪ Infants born to HBV infected mothers
▪ Individuals with chronically elevated amino alanine A dditiona l In
transferase (ALT) or aspartate amino transferase (AST) form at ion
of unknown etiology
Clinical Policy Bulletin
▪ Individuals with HIV
Notes
▪ Injection drug users
▪ Men who have sexual contact with men
▪ Persons needing immunosuppressive therapy, including
chemotherapy, immunosuppression related to organ
transplantation, and immunosuppression for
rheumatologic or gastroenterologic disorders

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▪ Persons who are the sources of blood or body fluids

resulting in an exposure (e.g., needlestick, sexual
assault) that might require post-exposure prophylaxis
▪ Pregnant women
▪ U.S. born persons not vaccinated as infants whose
parents were born in regions with high HBV endemicity
(greater than or equal to 8 %), such as sub-Saharan
Africa, southeast and central Asia, and China.

Aetna considers hepatitis C virus (HCV) screening medically

necessary for the following individuals:

▪ Children born to HCV infected mothers

▪ Children from a region with high prevalence of HCV
infection.
▪ Current or former hemodialysis individuals
▪ Individuals who received blood transfusions or organ
transplants prior to July, 1992 or who received blood
from a donor who later tested positive for HCV infection
▪ Individuals who received clotting factor concentrates
produced before 1987
▪ Individuals with HIV
▪ Individuals with persistently abnormal ALT levels
▪ Individuals with a recognized exposure such as health
care workers, emergency medical personnel or public
safety workers after needle sticks, sharps or mucosal
exposures to HCV positive blood
▪ Injection drug users
▪ Present sexual partners of HCV-infected persons

Aetna considers one-time testing without prior ascertainment

of HCV risk medically necessary for persons born between
1945 to1965.

See also: CPB 0048 - Hepatitis A Vaccine (../1_99/0048.html)

, CPB 0410 - Hepatitis B Vaccine (../400_499/0410.html).

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Background
Hepatitis refers to inflammation of the liver and also refers to a
group of viral infections that affect the liver. The most common
types are Hepatitis A, Hepatitis B, and Hepatitis C, although
Hepatitis D and E viruses have also been identified. An
estimated 4.4 million Americans are living with chronic
hepatitis, the majority of whom do not know they are infected.
Viral hepatitis is the leading cause of liver cancer and the most
common reason for liver transplantation (CDC Division of Viral
Hepatitis, 2012).

Transmission of hepatitis A, which is caused by hepatitis A

virus (HAV), occurs by the fecal-oral route through direct
contact with an HAV-infected person or by ingestion of HAV-
contaminated food or water. Foodborne or waterborne
hepatitis A outbreaks are relatively uncommon in the United
States, but food handlers with hepatitis A are frequently
identified, and evaluation of the need for immunoprophylaxis
and implementation of control measures are a considerable
burden on public health resources. It is also notable that HAV-
contaminated food may be the source of hepatitis A for an
unknown proportion of persons whose source of infection is
not identified (Fiore, 2004).

Torner et al (2012) reported that although hepatitis A mass

vaccination effectiveness is high, outbreaks continue to occur.
They investigated the association between duration and
characteristics of hepatitis A outbreaks reported between 1991
and 2007. An outbreak was defined as greater than or equal
to 2 epidemiologically-linked cases with greater than or equal
o 1 case laboratory-confirmed by detection of HA
immunoglobulin M (IgM) antibodies. Between 1991 and 2007,
268 outbreaks (rate 2.45 per million persons-year) and 1,396
cases (rate 1.28 per 10(5) persons-year) were reported.
Factors associated with shorter duration were time to
intervention (OR = 0.96; 95 % confidence interval [CI]: 0.94 to
0.98) and school setting (OR = 0.39; 95 % CI: 0.16 to 0.92).

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However, the authors also noted that in person-to-person

transmission outbreaks, only time to intervention was
associated with shorter outbreak duration (OR = 0.96; 95 %
CI: 0.95 to 0.98). Torner et al concluded that making
confirmed HA infections statutory reportable for clinical
laboratories could diminish outbreak duration.

Wiersma et al (2011) reported that most of the estimated 350

million people with chronic hepatitis B virus (HBV) live in
resource-constrained settings and that up to 25 % of those
persons will die prematurely of hepatocellular carcinoma or
cirrhosis. They further state that an informal World Health
Organization consultation of experts concluded that chronic
HBV is a major public health problem in emerging nations, all
HIV-infected persons should be screened for HBV infection,
HIBV/HBV co-infected persons should be treated with
therapies active against both viruses and that reduce the risk
of resistance, and that standards for the management of
chronic HBV infection should be adapted to resource-
constrained settings.

Hepatitis B, which is caused by infection with the HBV, is

found in highest concentrations in blood and in lower
concentrations in other body fluids (e.g., semen, vaginal
secretions, and wound exudates). HBV is efficiently
transmitted by percutaneous or mucous membrane exposure
to infectious blood or body fluids that contain blood. In adults,
approximately half of newly acquired HBV infections are
symptomatic, and approximately 1 % of reported cases result
in acute liver failure and death. Risk for chronic infection is
inversely related to age at infection, with approximately 90 %
of infected infants and 3 0% of infected children aged less than
5 years becoming chronically infected, compared with 2 % to 6
% of adults. Among persons with chronic HBV infection, the
risk for premature death from cirrhosis or hepatocellular
carcinoma is 15 % to 25 %. The primary risk factors that have
been associated with infection are unprotected sex with an
infected partner, birth to an infected mother, unprotected sex

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with more than one partner, men who have sex with other
men, history of other sexually transmitted diseases, and illegal
injection drug use (CDC Division of Viral Hepatitis, 2012). The
United States Preventive Services Task Force (USPSTF)
strongly recommends screening for HBV in pregnant women at
their first prenatal visit. The USPSTF recommends against
routinely screening the general asymptomatic population for
chronic HBV infection (USPSTF, 2004).

Weinbaum et al (2009) reported that “early identification of

persons with chronic HBV infection enables infected persons
to receive necessary care to prevent or delay onset of liver
disease, and enables the identification and vaccination of
susceptible household contacts and sex partners, interrupting
ongoing transmission.” The authors emphasized that testing
had been recommended previously to enable primary
prevention of HBV infection among close contacts for pregnant
women, household contacts and sex partners of HBV-infected
persons, persons born in countries with hepatitis B surface
antigen (HBsAg) prevalence of more than 8 %, persons who
are the source of blood or body fluid exposures that might
warrant post-exposure prophylaxis (e.g., needlestick injury to a
healthcare worker or sexual assault), and to enable
appropriate treatment for infants born to HBsAg-positive
mothers and persons infected with human immunodeficiency
virus. With the increasing availability of efficacious hepatitis B
treatment, the CDC published updated recommendations for
public health evaluation and management for chronically
infected persons and their contacts which extended testing
recommendations to include persons born in geographic
regions with HBsAg prevalence of greater than 2 %, men who
have sex with men, and injection drug users.

The CDC, in collaboration with the New York City (NYC)

Department of Health and Mental Hygiene (DOHMH),
conducted a chronic HBV surveillance, selecting a random
sample of newly reported cases and collecting more detailed
information from the patients' clinicians. Analysis was

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presented on 180 randomly selected HBV cases reported

during June 2008 to November 2009. Approximately two-
thirds (67 %) of the patients were Asian, and the most
commonly reported reason for HBV testing was the patient's
birth country or race/ethnicity (27 %). In 70 % of cases, the
clinician did not know of any patient risk factors and 62 % did
not know their patient's hepatitis A vaccination status despite
recommendations. Sixty-nine percent of clinicians stated that
they counseled their patients about notifying close contacts
about their infection, and 75 % counseled about transmission
and prevention. This surveillance effort provided quantitative
data on health disparities, illustrating that not all patients
received recommended prevention and treatment services. In
response to these findings, DOHMH now routinely distributes
HBV patient education materials to populations in need (CDC,
2012).

HCV infection is the most common chronic bloodborne

infection in the United States, with approximately 3.2 million
persons chronically infected. Sixty to 70 % of persons newly
infected with HCV typically are asymptomatic or have a mild
clinical illness. HCV RNA can be detected in blood within 1 to
3 weeks after exposure, the average time from exposure to
antibody to HCV (anti-HCV) seroconversion is 8 to 9 weeks,
and anti-HCV can be detected in greater than 97 % of persons
by 6 months after exposure. Chronic HCV infection develops
in 70 % to 85 % of HCV-infected persons and 60 % to 70 % of
chronically infected persons have evidence of active liver
disease. Although the majority of infected persons may not be
aware of their infection, infected persons serve as a source of
transmission to others and are at risk for chronic liver disease
or other HCV-related chronic diseases decades after infection
occurs. HCV is most efficiently transmitted through large or
repeated percutaneous exposure to infected blood (e.g.,
through transfusion of blood from unscreened donors or
through use of injecting drugs). Although much less frequent,
occupational, perinatal, and sexual exposures also can result
in transmission of HCV (CDC Division of Viral Hepatitis, 2012).

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Denniston et al (2012) discussed that many persons infected

with hepatitis C virus (HCV) are unknown to the healthcare
system because they may be asymptomatic for years, have
not been tested for HCV infection, and only seek medical care
when they develop liver-related complications. The authors
analyzed data from persons who tested positive for past or
current HCV infection during participation in the National
Health and Nutrition Examination Survey (NHANES) during the
years 2001 through 2008. They conducted a follow-up survey

6 months after examination to determine (i) how many

participants testing positive for HCV infection were aware

of their HCV status before being notified by NHANES, (ii)
what actions participants took after becoming aware of
their first positive test, and (iii) participants' knowledge
about hepatitis C. Of the 30,140 participants tested, 393 (1.3
%) had evidence of past or current HCV infection and 170 (43
%) could be contacted during the follow-up survey and
interviewed. Only 49.7 % were aware of their positive HCV
infection status before being notified by NHANES and only 3.7
% of these respondents reported that they had first been
tested for HCV because they or their doctor thought they were
at risk for infection. The study results showed that, overall,
85.4 % had heard of hepatitis C and that correct responses to
questions about hepatitis C were higher among persons 40 to
59 years of age, white non-Hispanics, and respondents who
saw a physician after their first positive HCV test. Eighty
percent of respondents indicated they had seen a doctor about
their first positive HCV test result. The investigators concluded
that these data indicated that fewer than 50 % of those
infected with HCV may be aware of their infection. The
findings suggest that more intensive efforts are needed to
identify and test persons at risk for HCV infection.

Smith et al (2012) reported that many of the 2.7 to 3.9 million

persons living with HCV infection, an increasing cause of
morbidity and mortality in the United States, are unaware they
are infected and do not receive care (e.g., education,

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counseling, and medical monitoring) and treatment. The CDC

estimates that although persons born between 1945 to1965
comprise an estimated 27 % of the population, they account
for approximately three-fourths of all HCV infections in the
United States, 73 % of HCV-associated mortality, and are at
greatest risk for hepatocellular carcinoma and other HCV-
related liver disease. The CDC is augmenting previous
recommendations for HCV testing to recommend one-time
testing without prior ascertainment of HCV risk for persons
born during 1945 to1965. These recommendations do not
replace previous guidelines for HCV testing that are based on
known risk factors and clinical indications, but rather define an
additional target population for testing: persons born during
1945 to 1965. The CDC developed these recommendations
with the assistance of a work group representing diverse
expertise and perspectives. The recommendations are
informed by the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) framework, an
approach that provides guidance and tools to define the
research questions, conduct the systematic review, assess the
overall quality of the evidence, and determine the strength of
the recommendations.

The United States Centers for Disease Control currently has in

place recommendations regarding screening for both hepatitis
B and hepatitis C. The USPSTF (Moyer, 2013) recommended
screening for HCV infection in persons at high risk for
infection. The USPSTF also recommended offering 1-time
screening for HCV infection to adults born between 1945 and
1965. (B recommendation).

The North American Society for Pediatric Gastroenterology,

Hepatology, and Nutrition (NASPGHAN)’s practice guidelines
on “Diagnosis and management of hepatitis C infection in
infants, children, and adolescents” (Mack et al, 2012) noted
that children from a region with high prevalence of HCV
infection as well as present sexual partners of HCV-infected
persons should be screened for HCV infection.

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Updated USPSTF recommendations on screening for HBV

were published in May, 2014. These recommendations are
based on current evidence on the benefits and harms of
antiviral therapy, the benefits of education on behavior change
counseling, and the association between improvements in
intermediate and clinical outcomes after antiviral therapy. The
recommendation updates are focused on high-risk populations
and reflect current evidence the USPSTF identified that HBV
vaccination is effective for decreasing disease acquisition in
high-risk populations. The risk for HBV infection varies
substantially by country of origin in foreign-born persons in the
United States (US), particularly persons born in countries with
a prevalence of HBV infection of 2% or greater. The
recommendations further note that lack of vaccination in
infancy in US-born persons with parents from a country or
region with high prevalence (≥ 8%). including sub-Saharan
Africa, central and southeast Asia, and China, is an important
risk factor (USPSTF, 2014).

The Centers for Medicare and Medicaid (CMS) issued a

National Coverage Determination on June 2, 2014 stating that
"the evidence is adequate to conclude that screening for HCV,
in accord with the USPSTF recommendations, is reasonable
and necesasry for the prevention or early detection of an
illness or disability and is appropriate for individuals entitled to
benefits under Part A or erolled under Part B." Therefore, CMS
will cover screening for HCV for beneficiaries who are adults at
high risk for HCV infection, high risk being defined as a current
or past history of illicit injection drug use or a history of
receiving blood transfusion prior to 1992, CMS will also cover
a single screening test for adults who do not meet the CMS
definition of high risk, but who were born from 1945 through
1965.

Hwang et al (2015) provided a revised opinion on “Hepatitis B

virus screening for patients with cancer before therapy” based
on the American Society of Clinical Oncology (ASCO) panel’s
consensus opinion in the context of an evolving database. This

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updated provisional clinical opinion introduced a risk-adaptive

strategy to identify and treat patients with HBV infection to
reduce their risk of HBV re-activation. Medical providers
should screen by testing patients for HBV infection before
starting anti-CD20 therapy or hematopoietic cell
transplantation. Providers should also screen patients with risk
factors for HBV infection. Screening should include both
hepatitis B surface antigen (HBsAg) and hepatitis B core
antibody (anti-HBc), because re-activation can occur in
patients who are HBsAg positive/anti-HBc positive or HBsAg
negative/anti-HBc positive. Either total anti-HBc or anti-HBc
immunoglobulin G (not immunoglobulin M) test should be
used. Clinicians should start anti-viral therapy for HBsAg-
positive/anti-HBc–positive patients before or
contemporaneously with cancer therapy and monitor HBsAg-
negative/anti-HBc–positive patients for re-activation with HBV
DNA and ALT levels, promptly starting anti-virals if re-
activation occurs. Clinicians can initiate anti-virals for HBsAg-
negative/anti-HBc–positive patients anticipating cancer
therapies associated with a high risk of re-activation, or they
can monitor HBV DNA and ALT levels and initiate on-demand
anti-virals. For patients who neither have HBV risk factors nor
anticipate cancer therapy associated with a high risk of re-
activation, current evidence does not support HBV screening
before initiation of cancer therapy.

The ASCO panel suggests HBV screening for patients with

cancer and HBV risk factors before initiation of systemic
cancer therapy. Risk groups include the following:

• Persons born in countries and regions with prevalence

of HBV infection greater than or equal to 2 %
• US-born persons not vaccinated as infants whose
parents were born in regions with high prevalence of
HBV infection (greater than or equal to 8 %; e.g., sub-
Saharan Africa, southeast and central Asia)
• HIV-positive persons

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• Injection drug users

• Men who have sex with men
• Those with household or sexual contact with persons
with HBV infection

The American Gastroenterological Association (AGA)’s

guideline on “The prevention and treatment of hepatitis B virus
reactivation during immunosuppressive drug therapy” (Reddy
et al, 2015) recommended screening for HBV (HBsAg and anti-
HBc, followed by a sensitive HBV DNA test if positive) in
patients at moderate or high risk who will undergo
immunosuppressive drug therapy. The AGA recommended
against routinely screening for HBV in patients who will
undergo immunosuppressive drug therapy and are at low risk.

The Centers for Medicare and Medicaid Services (CMS,

2016) has determined that a screening test is covered for
asymptomatic, nonpregnant adolescents and adults at high
risk for HBV infection. "High risk" is defined as persons born in
countries and regions with a high prevalence of HBV infection
(i.e., ≥ 2%), U.S.-born persons not vaccinated as infants
whose parents were born in regions with a very high
prevalence of HBV infection (i.e., ≥ 8%), HIV-positive persons,
men who have sex with men, injection drug users, household
contacts or sexual partners of persons with HBV infection. In
addition, CMS has determined that repeated screening would
be appropriate annually only for beneficiaries with continued
high risk (i.e., men who have sex with men, injection drug
users, household contacts or sexual partners of persons with
HBV infection) who do not receive hepatitis B vaccination.

CMS (2016) has stated that a screening test at the first

prenatal visit is covered for pregnant women and then
rescreening at time of delivery for those with new or continuing
risk factors. In addition, CMS has determined that screening
during the first prenatal visit would be appropriate for each

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pregnancy, regardless of previous hepatitis B vaccination or

previous negative hepatitis B surface antigen (HBsAg) test
results.

A ppendix
Geographic regions with an HBsAg prevalence ≥2% *

Region† Countries‡

Africa All

Asia§ All

Australia and All except Australia and New Zealand

South Pacific

Middle East All except Cyprus and Israel

Eastern All except Hungary

Europe

Western Malta, Spain, and indigenous populations

Europe in Greenland

North America Alaska natives and indigenous populations

in northern Canada

Mexico and Guatemala and Honduras

Central
America

South America Ecuador, Guyana, Suriname, Venezuela,

and Amazonian areas of Bolivia, Brazil,
Colombia, and Peru

Caribbean Antigua and Barbuda, Dominica, Grenada,

Haiti, Jamaica, St. Kitts and Nevis, St.
Lucia, and Turks and Caicos Islands

Adapted from Weinbaum et al, 2008.

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*
Estimates of prevalence of HBsAg, a marker of chronic
hepatitis B virus infection, are based on limited data and might
not reflect current prevalence in countries that have
implemented childhood hepatitis B vaccination. In addition,
HBsAg prevalence might vary within countries by
subpopulation and locality.
†
The regions with the highest prevalence (>5%) are sub-
Saharan Africa and central and southeast Asia.

‡
A complete list of countries in each region is available at the
CDC’s “Vaccines. Medicines. Advice” webpage.

§
Asia includes three regions: Southeast Asia, east Asia, and
northern Asia.

CPT Codes / HCPCS Codes / ICD-10 Codes

Information in the [brackets] below has been added for

clarification purposes. Codes requiring a 7th character are
represented by "+":

Code Code Description

Hepatitis B Virus (HBV) screening:

CPT codes covered if selection criteria are met:

86704 Hepatitis B core antibody (HBcAb); total

86705 IgM antibody

86706 Hepatitis B surface antibody (HBsAb)

87340 Infectious agent antigen detection by

immunoassay technique, (eg, enzyme
immunoassay [EIA], enzyme-linked
immunosorbent assay [ELISA],
immunochemiluminometric assay [IMCA])
qualitative or semiquantitative, multiple-step
method; hepatitis B surface antigen (HBsAg)

87341 hepatitis B surface antigen (HBsAg)

neutralization

HCPCS codes covered if selection criteria are met:

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Code Code Description

G0499 Hepatitis b screening in non-pregnant, high risk

individual includes hepatitis b surface antigen
(hbsag) followed by a neutralizing confirmatory
test for initially reactive results, and antibodies
to hbsag (anti-hbs) and hepatitis b core antigen
(anti-hbc)

ICD-10 codes covered if selection criteria are met:

B20 Human immunodeficiency virus [HIV] disease

B97.35 Human immunodeficiency virus, type 2 [HIV 2]

as the cause of diseases classified elsewhere

F11.10 - Opioid related disorders [injecting drug users]

F11.99

F13.10 - Sedative, hypnotic, or anxiolytic related

F13.99 disorders [injecting drug users]

F14.10 - Cocaine related disorders [injecting drug users]

F14.99

F15.10 - Other stimulant related disorders [injecting drug

F15.99 users]

O10.011 - Edema, proteinuria and hypertensive disorders

O16.9 in pregnancy, childbirth and the puerperium

O20.0 - Other maternal disorders predominantly related

O29.93 to pregnancy

R74.0 Nonspecific elevation of levels of transaminase

or lactic acid dehydrogenase [LDH][ALT or
AST]

Z20.2 Contact with and (suspected) exposure to

infections with a predominantly sexual mode of
transmission

Z20.5 Contact with and (suspected) exposure to viral

hepatitis

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Code Code Description

Z20.6 Contact with and (suspected) exposure to

human immunodeficiency virus [HIV]

Z21 Asymptomatic human immunodeficiency virus

[HIV] infection status

Z22.4 Carrier of infections with a predominantly

sexual mode of transmission

Z22.50 - Carrier of viral hepatitis

Z22.59

Z34.00 - Encounter for supervision of normal pregnancy

Z34.93

Z51.11 Encounter for antineoplastic chemotherapy

Z72.51 - High-risk sexual behavior

Z72.53

Z94.0 - Transplanted organ and tissue status

Z94.9

Z99.2 Dependence on renal dialysis

Hepatitis C Virus (HCV) screening:

CPT codes covered if selection criteria are met:

86803 Hepatitis C antibody

86804 Confirmatory test (eg, immunoblot)

HCPCS codes covered if selection criteria are met:

G0472 Hepatitis C antibody screening for individual at

high risk and other coverage indication(s)

ICD-10 codes covered if selection criteria are met (not all

inclusive):

B20 Human immunodeficiency virus [HIV] disease

B97.35 Human immunodeficiency virus, type II [HIV-2]

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Code Code Description

D65 - Coagulation defects, purpura and other

D69.9 hemorrhagic conditions

F11.10 - Opioid related disorders [injecting drug users]

F11.99

F13.10 - Sedative, hypnotic, or anxiolytic related

F13.99 disorders [injecting drug users]

F14.10 - Cocaine related disorders [injecting drug users]

F14.99

F15.10 - Other stimulant related disorders [injecting drug

F15.99 users]

T80.61X+ Other serum reaction due to administration of

blood products [Blood transfusion, without
reported diagnosis]

Z20.5 Contact with and (suspected) exposure to viral

hepatitis

Z22.50 - Carrier of viral hepatitis

Z22.59

Z94.0 - Transplanted organ or tissue status

Z94.9

Z99.2 Dependence on renal dialysis

The above policy is based on the following

references:

1. Fiore AE. Hepatitis A transmitted by food. Clinical

Infectious Diseases. 2004;38:705-715.
2. US Preventive Services Task Force (USPSTF). Screening
for hepatitis B infection, topic page. Rockville, MD: U.S.
Preventive Services Task Force; 2004. Available at:

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http://www.uspreventiveservicestaskforce.org/uspstf/uspshepb.htm.
Accessed August 28, 2012.
3. Weinbaum CM, Mast EE, Ward JW. Recommendations
for identification and public health management of
persons with chronic hepatitis B virus infection.
Hepatology. 2009;49(5 Suppl):S35-S44.
4. Wiersma ST, McMahon B, Pawlotsky JM, et al.
Treatment of chronic hepatitis B virus infection in
resource-constrained settings: Expert panel
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5. Centers for Disease Control and Prevention (CDC).
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GA: Centers for Disease Control and Prevention; 2012.
Available at:
http://www.cdc.gov/hepatitis/. Accessed August 23,
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7. Denniston MM, Klevens RM, McQuillan GM, Jiles RB.
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8. Smith BD, Morgan RL, Beckett GA. Recommendations
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9. Torner N, Broner S, Martinez A, et al. Factors
associated to duration of hepatitis a outbreaks:
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NASPGHAN practice guidelines: Diagnosis and
management of hepatitis C infection in infants,
children, and adolescents. J Pediatr Gastroenterol
Nutr. 2012;54(6):838-855.

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11. Moyer VA; U.S. Preventive Services Task Force.

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Gastroenterological Association Institute guideline on
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reactivation during immunosuppressive drug therapy.
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17. van Rooijen M, Heijman T, de Vrieze N, et al. Earlier
detection of hepatitis C virus infection through routine
hepatitis C virus antibody screening of human
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with men attending a sexually transmitted infection
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18. Centers for Medicare & Medicaid Services (CMS).

Screening for hepatitis B virus (HBV) infection.
Decision Memorandum #CAG-00447N. Baltimore, MD:
CMS; September 28, 2016.
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20. Brady JE, Liffmann DK, Yartel A, et al. Uptake of
hepatitis C screening, characteristics of patients tested,
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21. Federman AD, Kil N, Kannry J, et al. An electronic
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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan

benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial,

general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care
services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors

in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely

responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is

subject to change.

Copyright © 2001-2018 Aetna Inc.

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 AETNA BETTER HEALTH® OF PENNSYLVANIA

Amendment to
Aetna Clinical Policy Bulletin Number:
0835 Hepatitis Screening
Screening for Hepatitis B and C do not require prior authorization for the Pennsylvania Medical Assistance plan.

www.aetnabetterhealth.com/pennsylvania Updated 12/06/2017