Summary & Overview

HCPCS G9454: One-Time HCV Screening, No Prior Documentation

HCPCS Level II code G9454 documents a one-time hepatitis C virus (HCV) screening that was not completed within the current 12-month reporting period and for which there is no record of prior screening; no reason for omission is provided. This code matters nationally as HCV screening is a public health priority tied to early diagnosis and linkage to treatment, and standardized reporting supports quality measurement and population health monitoring. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically and operationally, how it is used in reporting and quality measurement, and which service settings typically submit the code. The publication also outlines typical modifiers and billing considerations, summarizes common use cases in ambulatory and preventive care workflows, and highlights areas where documentation drives correct code assignment. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line is noted in the detailed sections. This summary is intended for national audiences involved in billing, compliance, and clinical quality programs seeking concise guidance on code G9454.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9454HCPCS Level IIHCV screeninghepatitis Cpreventive carequality reportingambulatory carediagnostic screening

Billing Code Overview

HCPCS Level II code G9454 describes a one-time screening for HCV infection when the screening was not received within the 12-month reporting period and there is no documentation of prior screening for HCV infection, with the reason for omission not given. The service type is one-time infectious disease screening focused on hepatitis C virus (HCV). The typical site of service is outpatient preventive or ambulatory care settings where screening services are provided during a clinical visit.

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient presents for a routine primary care visit with no documented history of prior hepatitis C virus (HCV) screening in the medical record. The clinician reviews preventive care needs and identifies that the patient has not received an HCV test within the current 12-month reporting period and there is no documentation of prior HCV screening. After brief counseling about infectious disease screening, the clinician orders a one-time HCV antibody test and documents the lack of prior screening and that reason for prior non-screening is not provided. The specimen is collected in the office laboratory or outpatient phlebotomy area; results are posted to the electronic health record and communicated to the patient. If the antibody test is reactive, reflex confirmatory HCV RNA testing is ordered per laboratory protocol and linkage-to-care referral workflows are initiated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to order, obtain, and document counseling and administrative tasks is substantially greater than typical for a one-time screening visit.
`23`	Unusual anesthesia	Not typically used for office HCV screening; not applicable unless unusual anesthesia is required for specimen collection.
`52`	Reduced services	Use if screening encounter was partially reduced or abbreviated compared with standard service delivery.
`53`	Discontinued procedure	Use if specimen collection was started but discontinued for clinical reasons prior to completion.
`54`	Surgical care only	Not applicable to screening blood tests; rarely used.
`55`	Postoperative management only	Not applicable to HCV screening.
`56`	Preoperative management only	Not applicable to HCV screening.
`62`	Two surgeons	Not applicable to HCV screening.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable to HCV screening.
`CO`	Left for payer-specific contractual reasons	Use per payer rules when another payer is primary or for contractual billing arrangements.
`CQ`	Service furnished by a CA QHP (physician assistant or other)	Use when applicable to indicate a CA-qualified health professional provided the service (state-specific).
`FX`	Physician not present, services performed via telehealth by certified remote lab	Use when local lab phlebotomy performed with remote physician oversight (situational).
`FY`	Professional component of telehealth service	Use if billing requires separation of professional component for telehealth review of results.
`QK`	Medical direction of two or more qualified individuals	Use for supervision and direction qualifiers if applicable to staff performing the screening.
`QX`	Services performed by a physician’s assistant	Use when a physician assistant performs the screening/ordering and billing rules require this modifier.

Taxonomy Code	Specialty	Notes
208D00000X	Family Medicine	Most common setting for preventive screening and ordering HCV tests.
208000000X	Internal Medicine	Primary care internists often perform routine HCV screening and follow-up.
207Q00000X	Obstetrics & Gynecology	OB/GYN clinicians screen pregnant patients and women of reproductive age for HCV as indicated.
363L00000X	Laboratory Director	Clinical pathology/laboratory medicine providers oversee testing and reflex protocols.
332B00000X	Infectious Disease	Specialists manage confirmatory testing and linkage-to-care for positive results.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z11.59`	Encounter for screening for other viral diseases	General screening code that may be used for screening tests including HCV when applicable.
`Z11.3`	Encounter for screening for infections with a predominantly sexual mode of transmission	Used when screening relates to sexually transmitted infection prevention, including HCV screening contexts.
`Z20.9`	Contact with and (suspected) exposure to unspecified communicable disease	Use when there is known exposure or concern prompting screening.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used when HCV screening is part of routine preventive exam.
`Z13.6`	Encounter for screening for other diseases and disorders	Generic screening code that can support preventive screening documentation including HCV.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Commonly performed at the same visit to obtain specimen for HCV antibody testing.
`87635`	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C virus, amplified probe technique (HCV RNA)	Used for confirmatory testing when initial HCV antibody is reactive.
`80053`	Comprehensive metabolic panel (CMP)	Often ordered concurrently to assess baseline liver and metabolic function in patients with positive HCV screening.
`80061`	Lipid panel	May be ordered during preventive visits; not specific to HCV but commonly bundled in preventive labs.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) for an individual; approximately 15 minutes	May be billed when substantial counseling about HCV screening and implications is provided during the visit.