HIV Testing Diagnosis - Sonora Quest

HIV Testing (Diagnosis)

National Coverage Determination

CPT Codes:

Code 86689

86701 86702 86703 87390

87391

87534 87535 87537 87538

Description

Qualitative or semiquantitative immunoassays performed by multiple step methods; HTLV or HIV antibody, confirmatory test (for example, Western Blot) Antibody; HIV-1

Antibody; HIV-2 Antibody; HIV-1 and HIV-2, single assay Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-1 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-2 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique

Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique

Code A02.1 A07.2 A07.3 A07.8 A15.0 A15.4 A15.5 A15.6 A15.7 A15.8 A15.9 A17.0 A17.1 A17.81 A17.82 A17.83 A17.89 A17.9 A18.01 A18.02 A18.03 A18.09 A18.10 A18.11 A18.12 A18.13 A18.14 A18.15 A18.16 A18.17 A18.18

Description Salmonella sepsis Cryptosporidiosis Isosporiasis Other specified protozoal intestinal diseases Tuberculosis of lung Tuberculosis of intrathoracic lymph nodes Tuberculosis of larynx, trachea and bronchus Tuberculous pleurisy Primary respiratory tuberculosis Other respiratory tuberculosis Respiratory tuberculosis unspecified Tuberculous meningitis Meningeal tuberculoma Tuberculoma of brain and spinal cord Tuberculous meningoencephalitis Tuberculous neuritis Other tuberculosis of nervous system Tuberculosis of nervous system, unspecified Tuberculosis of spine Tuberculous arthritis of other joints Tuberculosis of other bones Other musculoskeletal tuberculosis Tuberculosis of genitourinary system, unspecified Tuberculosis of kidney and ureter Tuberculosis of bladder Tuberculosis of other urinary organs Tuberculosis of prostate Tuberculosis of other male genital organs Tuberculosis of cervix Tuberculous female pelvic inflammatory disease Tuberculosis of other female genital organs

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code A18.2 A18.31 A18.32 A18.39 A18.4 A18.50 A18.51 A18.52 A18.53 A18.54 A18.59 A18.6 A18.7 A18.81 A18.82 A18.83 A18.84 A18.85 A18.89 A19.0 A19.1 A19.2 A19.8 A19.9 A28.1 A31.0 A31.1 A31.2 A31.8 A31.9 A32.0 A32.11 A32.12 A32.7 A32.81 A32.82 A32.89 A32.9 A40.3 A41.52 A42.0 A42.1 A42.2 A42.81 A42.82 A42.89 A42.9 A43.0 A43.1 A43.8

Description Tuberculous peripheral lymphadenopathy Tuberculous peritonitis Tuberculous enteritis Retroperitoneal tuberculosis Tuberculosis of skin and subcutaneous tissue Tuberculosis of eye, unspecified Tuberculous episcleritis Tuberculous keratitis Tuberculous chorioretinitis Tuberculous iridocyclitis Other tuberculosis of eye Tuberculosis of (inner) (middle) ear Tuberculosis of adrenal glands Tuberculosis of thyroid gland Tuberculosis of other endocrine glands Tuberculosis of digestive tract organs, not elsewhere classified Tuberculosis of heart Tuberculosis of spleen Tuberculosis of other sites Acute miliary tuberculosis of a single specified site Acute miliary tuberculosis of multiple sites Acute miliary tuberculosis, unspecified Other miliary tuberculosis Miliary tuberculosis, unspecified Cat-scratch disease Pulmonary mycobacterial infection Cutaneous mycobacterial infection Disseminated mycobacterium avium-intracellulare complex (DMAC) Other mycobacterial infections Mycobacterial infection, unspecified Cutaneous listeriosis Listerial meningitis Listerial meningoencephalitis Listerial sepsis Oculoglandular listeriosis Listerial endocarditis Other forms of listeriosis Listeriosis, unspecified Sepsis due to Streptococcus pneumoniae Sepsis due to Pseudomonas Pulmonary actinomycosis Abdominal actinomycosis Cervicofacial actinomycosis Actinomycotic meningitis Actinomycotic encephalitis Other forms of actinomycosis Actinomycosis, unspecified Pulmonary nocardiosis Cutaneous nocardiosis Other forms of nocardiosis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code A43.9 A44.0 A44.1 A44.8 A44.9 A48.1 A50.01 A50.02 A50.03 A50.04 A50.05 A50.06 A50.07 A50.08 A50.09 A50.1 A50.2 A50.30 A50.31 A50.32 A50.39 A50.40 A50.41 A50.42 A50.43 A50.44 A50.45 A50.49 A50.51 A50.52 A50.53 A50.54 A50.55 A50.56 A50.57 A50.59 A50.6 A50.7 A50.9 A51.0 A51.1 A51.2 A51.31 A51.32 A51.39 A51.41 A51.42 A51.43 A51.44 A51.45

Description Nocardiosis, unspecified Systemic bartonellosis Cutaneous and mucocutaneous bartonellosis Other forms of bartonellosis Bartonellosis, unspecified Legionnaires' disease Early congenital syphilitic oculopathy Early congenital syphilitic osteochondropathy Early congenital syphilitic pharyngitis Early congenital syphilitic pneumonia Early congenital syphilitic rhinitis Early cutaneous congenital syphilis Early mucocutaneous congenital syphilis Early visceral congenital syphilis Other early congenital syphilis, symptomatic Early congenital syphilis, latent Early congenital syphilis, unspecified Late congenital syphilitic oculopathy, unspecified Late congenital syphilitic interstitial keratitis Late congenital syphilitic chorioretinitis Other late congenital syphilitic oculopathy Late congenital neurosyphilis, unspecified Late congenital syphilitic meningitis Late congenital syphilitic encephalitis Late congenital syphilitic polyneuropathy Late congenital syphilitic optic nerve atrophy Juvenile general paresis Other late congenital neurosyphilis Clutton's joints Hutchinson's teeth Hutchinson's triad Late congenital cardiovascular syphilis Late congenital syphilitic arthropathy Late congenital syphilitic osteochondropathy Syphilitic saddle nose Other late congenital syphilis, symptomatic Late congenital syphilis, latent Late congenital syphilis, unspecified Congenital syphilis, unspecified Primary genital syphilis Primary anal syphilis Primary syphilis of other sites Condyloma latum Syphilitic alopecia Other secondary syphilis of skin Secondary syphilitic meningitis Secondary syphilitic female pelvic disease Secondary syphilitic oculopathy Secondary syphilitic nephritis Secondary syphilitic hepatitis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code A51.46 A51.49 A51.5 A51.9 A52.00 A52.01 A52.02 A52.03 A52.04 A52.05 A52.06 A52.09 A52.10 A52.11 A52.12 A52.13 A52.14 A52.15 A52.16 A52.17 A52.19 A52.2 A52.3 A52.71 A52.72 A52.73 A52.74 A52.75 A52.76 A52.77 A52.78 A52.79 A52.8 A52.9 A53.0 A53.9 A54.00 A54.01 A54.02 A54.03 A54.09 A54.1 A54.21 A54.22 A54.23 A54.24 A54.29 A54.30 A54.31 A54.32

Description Secondary syphilitic osteopathy Other secondary syphilitic conditions Early syphilis, latent Early syphilis, unspecified Cardiovascular syphilis, unspecified Syphilitic aneurysm of aorta Syphilitic aortitis Syphilitic endocarditis Syphilitic cerebral arteritis Other cerebrovascular syphilis Other syphilitic heart involvement Other cardiovascular syphilis Symptomatic neurosyphilis, unspecified Tabes dorsalis Other cerebrospinal syphilis Late syphilitic meningitis Late syphilitic encephalitis Late syphilitic neuropathy Charcot's arthropathy (tabetic) General paresis Other symptomatic neurosyphilis Asymptomatic neurosyphilis Neurosyphilis, unspecified Late syphilitic oculopathy Syphilis of lung and bronchus Symptomatic late syphilis of other respiratory organs Syphilis of liver and other viscera Syphilis of kidney and ureter Other genitourinary symptomatic late syphilis Syphilis of bone and joint Syphilis of other musculoskeletal tissue Other symptomatic late syphilis Late syphilis, latent Late syphilis, unspecified Latent syphilis, unspecified as early or late Syphilis, unspecified Gonococcal infection of lower genitourinary tract, unspecified Gonococcal cystitis and urethritis, unspecified Gonococcal vulvovaginitis, unspecified Gonococcal cervicitis, unspecified Other gonococcal infection of lower genitourinary tract Gonococcal infection of lower genitourinary tract with periurethral and accessory gland abscess Gonococcal infection of kidney and ureter Gonococcal prostatitis Gonococcal infection of other male genital organs Gonococcal female pelvic inflammatory disease Other gonococcal genitourinary infections Gonococcal infection of eye, unspecified Gonococcal conjunctivitis Gonococcal iridocyclitis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code A54.33 A54.39 A54.40 A54.41 A54.42 A54.43 A54.49 A54.5 A54.6 A54.81 A54.82 A54.83 A54.84 A54.85 A54.86 A54.89 A54.9 A55 A56.00 A56.01 A56.02 A56.09 A56.11 A56.19 A56.2 A56.3 A56.4 A56.8 A57 A58 A59.01 A60.00 A60.01 A60.02 A60.03 A60.04 A60.09 A60.1 A60.9 A63.0 A63.8 A64 A74.81 A74.89 A74.9 A81.2 A85.0 A85.1 A85.8 A86

Description Gonococcal keratitis Other gonococcal eye infection Gonococcal infection of musculoskeletal system, unspecified Gonococcal spondylopathy Gonococcal arthritis Gonococcal osteomyelitis Gonococcal infection of other musculoskeletal tissue Gonococcal pharyngitis Gonococcal infection of anus and rectum Gonococcal meningitis Gonococcal brain abscess Gonococcal heart infection Gonococcal pneumonia Gonococcal peritonitis Gonococcal sepsis Other gonococcal infections Gonococcal infection, unspecified Chlamydial lymphogranuloma (venereum) Chlamydial infection of lower genitourinary tract, unspecified Chlamydial cystitis and urethritis Chlamydial vulvovaginitis Other chlamydial infection of lower genitourinary tract Chlamydial female pelvic inflammatory disease Other chlamydial genitourinary infection Chlamydial infection of genitourinary tract, unspecified Chlamydial infection of anus and rectum Chlamydial infection of pharynx Sexually transmitted chlamydial infection of other sites Chancroid Granuloma inguinale Trichomonal vulvovaginitis Herpesviral infection of urogenital system, unspecified Herpesviral infection of penis Herpesviral infection of other male genital organs Herpesviral cervicitis Herpesviral vulvovaginitis Herpesviral infection of other urogenital tract Herpesviral infection of perianal skin and rectum Anogenital herpesviral infection, unspecified Anogenital (venereal) warts Other specified predominantly sexually transmitted diseases Unspecified sexually transmitted disease Chlamydial peritonitis Other chlamydial diseases Chlamydial infection, unspecified Progressive multifocal leukoencephalopathy Enteroviral encephalitis Adenoviral encephalitis Other specified viral encephalitis Unspecified viral encephalitis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code A87.1 A87.2 A88.8 A89 B00.0 B00.1 B00.2 B00.3 B00.4 B00.50 B00.51 B00.52 B00.53 B00.59 B00.7 B00.81 B00.82 B00.89 B00.9 B01.0 B01.11 B01.12 B01.2 B01.81 B01.89 B02.0 B02.1 B02.21 B02.22 B02.23 B02.24 B02.29 B02.30 B02.31 B02.32 B02.33 B02.34 B02.39 B02.7 B02.8 B02.9 B05.0 B05.1 B05.2 B05.3 B05.4 B05.81 B05.89 B07.0 B07.8

Description Adenoviral meningitis Lymphocytic choriomeningitis Other specified viral infections of central nervous system Unspecified viral infection of central nervous system Eczema herpeticum Herpesviral vesicular dermatitis Herpesviral gingivostomatitis and pharyngotonsillitis Herpesviral meningitis Herpesviral encephalitis Herpesviral ocular disease, unspecified Herpesviral iridocyclitis Herpesviral keratitis Herpesviral conjunctivitis Other herpesviral disease of eye Disseminated herpesviral disease Herpesviral hepatitis Herpes simplex myelitis Other herpesviral infection Herpesviral infection, unspecified Varicella meningitis Varicella encephalitis and encephalomyelitis Varicella myelitis Varicella pneumonia Varicella keratitis Other varicella complications Zoster encephalitis Zoster meningitis Postherpetic geniculate ganglionitis Postherpetic trigeminal neuralgia Postherpetic polyneuropathy Postherpetic myelitis Other postherpetic nervous system involvement Zoster ocular disease, unspecified Zoster conjunctivitis Zoster iridocyclitis Zoster keratitis Zoster scleritis Other herpes zoster eye disease Disseminated zoster Zoster with other complications Zoster without complications Measles complicated by encephalitis Measles complicated by meningitis Measles complicated by pneumonia Measles complicated by otitis media Measles with intestinal complications Measles keratitis and keratoconjunctivitis Other measles complications Plantar wart Other viral warts

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code B07.9 B08.1 B16.0 B16.1 B16.2 B16.9 B17.0 B17.10 B17.11 B17.8 B17.9 B18.0 B18.1 B18.2 B18.8 B18.9 B19.0 B19.10 B19.11 B19.20 B19.21 B19.9 B20 B25.0 B25.1 B25.2 B25.8 B25.9 B33.3 B34.3 B35.1 B36.0 B37.0 B37.1 B37.2 B37.3 B37.41 B37.42 B37.49 B37.5 B37.6 B37.7 B37.81 B37.82 B37.83 B37.84 B37.89 B37.9 B38.0

Description Viral wart, unspecified Molluscum contagiosum Acute hepatitis B with delta-agent with hepatic coma Acute hepatitis B with delta-agent without hepatic coma Acute hepatitis B without delta-agent with hepatic coma Acute hepatitis B without delta-agent and without hepatic coma Acute delta-(super) infection of hepatitis B carrier Acute hepatitis C without hepatic coma Acute hepatitis C with hepatic coma Other specified acute viral hepatitis Acute viral hepatitis, unspecified Chronic viral hepatitis B with delta-agent Chronic viral hepatitis B without delta-agent Chronic viral hepatitis C Other chronic viral hepatitis Chronic viral hepatitis, unspecified Unspecified viral hepatitis with hepatic coma Unspecified viral hepatitis B without hepatic coma Unspecified viral hepatitis B with hepatic coma Unspecified viral hepatitis C without hepatic coma Unspecified viral hepatitis C with hepatic coma Unspecified viral hepatitis without hepatic coma Human immunodeficiency virus [HIV] disease Cytomegaloviral pneumonitis Cytomegaloviral hepatitis Cytomegaloviral pancreatitis Other cytomegaloviral diseases Cytomegaloviral disease, unspecified Retrovirus infections, not elsewhere classified Parvovirus infection, unspecified Tinea unguium Pityriasis versicolor Candidal stomatitis Pulmonary candidiasis Candidiasis of skin and nail Candidiasis of vulva and vagina Candidal cystitis and urethritis Candidal balanitis Other urogenital candidiasis Candidal meningitis Candidal endocarditis Candidal sepsis Candidal esophagitis Candidal enteritis Candidal cheilitis Candidal otitis externa Other sites of candidiasis Candidiasis, unspecified Acute pulmonary coccidioidomycosis

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

HIV Testing (Diagnosis)

National Coverage Determination

Code B38.1 B38.2 B38.3 B38.4 B38.7 B38.81 B38.89 B38.9 B39.0 B39.1 B39.2 B39.3 B39.4 B39.5 B39.9 B40.0 B40.1 B40.2 B40.3 B40.7 B40.81 B40.89 B40.9 B41.0 B41.7 B41.8 B41.9 B44.0 B44.1 B44.2 B44.7 B44.89 B44.9 B45.0 B45.1 B45.2 B45.3 B45.7 B45.8 B45.9 B47.1 B47.9 B48.0 B48.4 B48.8 B55.0 B55.1 B55.2 B55.9 B58.00

Description Chronic pulmonary coccidioidomycosis Pulmonary coccidioidomycosis, unspecified Cutaneous coccidioidomycosis Coccidioidomycosis meningitis Disseminated coccidioidomycosis Prostatic coccidioidomycosis Other forms of coccidioidomycosis Coccidioidomycosis, unspecified Acute pulmonary histoplasmosis capsulati Chronic pulmonary histoplasmosis capsulati Pulmonary histoplasmosis capsulati, unspecified Disseminated histoplasmosis capsulati Histoplasmosis capsulati, unspecified Histoplasmosis duboisii Histoplasmosis, unspecified Acute pulmonary blastomycosis Chronic pulmonary blastomycosis Pulmonary blastomycosis, unspecified Cutaneous blastomycosis Disseminated blastomycosis Blastomycotic meningoencephalitis Other forms of blastomycosis Blastomycosis, unspecified Pulmonary paracoccidioidomycosis Disseminated paracoccidioidomycosis Other forms of paracoccidioidomycosis Paracoccidioidomycosis, unspecified Invasive pulmonary aspergillosis Other pulmonary aspergillosis Tonsillar aspergillosis Disseminated aspergillosis Other forms of aspergillosis Aspergillosis, unspecified Pulmonary cryptococcosis Cerebral cryptococcosis Cutaneous cryptococcosis Osseous cryptococcosis Disseminated cryptococcosis Other forms of cryptococcosis Cryptococcosis, unspecified Actinomycetoma Mycetoma, unspecified Lobomycosis Penicillosis Other specified mycoses Visceral leishmaniasis Cutaneous leishmaniasis Mucocutaneous leishmaniasis Leishmaniasis, unspecified Toxoplasma oculopathy, unspecified

Medicare Limited Coverage Tests ? Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) April 2018

Effective May 1, 2018

Medicare Limited Coverage Tests

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