Summary & Overview
HCPCS G0499: Hepatitis B Screening for High-Risk Non-Pregnant Individuals
HCPCS Level II code G0499 designates a comprehensive hepatitis B screening panel for non-pregnant, high-risk individuals, including HBsAg, anti-HBs, and anti-HBc, with a neutralizing confirmatory test performed when an initial HBsAg is reactive. This screening is important for identifying active infection, past exposure, or immunity and supports prevention, linkage to care, and public health surveillance nationwide. Payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find clinical context on what the panel tests indicate, typical sites of service where the panel is ordered, and operational considerations for billing and claims submission. The publication summarizes common modifiers and payer coverage patterns relevant to outpatient and community-based laboratory services, highlights documentation elements tied to high-risk screening, and outlines the confirmatory test pathway for reactive HBsAg results. The content is intended for billing managers, clinical laboratory directors, and policy analysts seeking concise guidance on coding and payer engagement for hepatitis B screening in high-risk, non-pregnant populations. Data not available in the input for payor-specific rates, associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code G0499 represents Hepatitis B screening in non-pregnant, high-risk individuals. The test panel includes hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti-HBs), and antibodies to hepatitis B core antigen (anti-HBc). When an initial HBsAg result is reactive, the screening is followed by a neutralizing confirmatory test if performed.
Service type: Laboratory screening panel for hepatitis B infection and immunity assessment.
Typical site of service: Clinical laboratory testing ordered in outpatient settings, public health clinics, community screening programs, and ambulatory care facilities.
Clinical & Coding Specifications
Clinical Context
A 28-year-old non-pregnant patient presents to a community sexual health clinic reporting recent high-risk exposures (multiple new sexual partners and a partner known to be hepatitis B surface antigen positive). The clinician documents risk factors and orders a hepatitis B screening panel (G0499) comprising hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc). If the initial HBsAg is reactive, a neutralizing confirmatory test is performed per the billing code description. Specimen collection occurs at the clinic’s outpatient laboratory; results are reviewed by the ordering clinician who documents counseling and follow-up plan (immunization if susceptible, linkage to care if infected). Typical workflow steps: patient intake and risk assessment, informed consent for testing, phlebotomy, laboratory analysis including confirmatory test if indicated, result review, and documentation of counseling and next steps in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |