NCD 210.12: Screening for HIV Infection
Medicare covers HIV screening for all Medicare beneficiaries aged 15-65 (and outside that range if increased risk) annually with no cost-sharing.
What's covered
- Annual screening for all adolescents and adults 15-65
- Annual screening outside 15-65 range for increased-risk individuals
- Pregnancy-related screening regardless of risk
Coverage criteria
- Annual interval for routine screening
- Increased-risk criteria for non-age-eligible patients (MSM, IDU, multiple partners, etc.)
- Lab-developed or FDA-approved test
Exclusions
- Diagnostic testing in symptomatic patients (separate coverage)
Common denial patterns
- Screening more frequent than annual without documentation of new risk exposure
- Risk documentation missing for non-15-65 age
Appeal citation
NCD 210.12 (HIV Screening), 2015. Cite age + interval or risk status.
Frequently asked questions
What does Medicare NCD 210.12 cover?
Medicare covers HIV screening for all Medicare beneficiaries aged 15-65 (and outside that range if increased risk) annually with no cost-sharing.
What are the coverage criteria?
Annual interval for routine screening; Increased-risk criteria for non-age-eligible patients (MSM, IDU, multiple partners, etc.); Lab-developed or FDA-approved test.
What is excluded?
Diagnostic testing in symptomatic patients (separate coverage).
How do I cite this NCD in an appeal?
NCD 210.12 (HIV Screening), 2015. Cite age + interval or risk status.
Other Preventive/Screening NCDs
Sources
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