CurrentBlue Cross Blue Shield - MichiganPolicy N/A

Routine hepatitis C screening

Defines coverage, payment, and billing rules for routine hepatitis C screening for Medicare Plus Blue Group PPO members (enhanced over Original Medicare); explains when screening is payable and applicable provider/member responsibilities.

Policy Summary

PayerBlue Cross Blue Shield - Michigan

PolicyRoutine hepatitis C screening

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit claims with CPT/HCPCS and diagnosis codes to highest specificity on CMS-1500, UB-04 or 837 and collect applicable member cost-sharing at time of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

EnhancedEnhanced vs Original Medicare

Lesser of Medicare or chargePayment basis

Screening coveredEligibility note

CMS-1500/UB-04/837Billing forms

Coverage Criteria for Routine Hepatitis C Screening

Coverage criteria

Coverage differs between Original Medicare and Medicare Plus Blue Group PPO:

Original Medicare: routine hepatitis C screening is not covered unless medically necessary for diagnostic purposes when signs or symptoms are present.

Medicare Plus Blue Group PPO: select plans provide enhanced coverage; hepatitis C screening is covered as a preventative screening test even if signs or symptoms are absent; member cost-sharing and other conditions are determined by the group.

Payment conditions (eligible provider, payable location, frequency, CPT codes, age restrictions, diagnosis restrictions) follow Original Medicare; diagnosis restrictions apply.

Coding and Frequency

CPT coding guidanceCPT

CPT codes for hepatitis C screening are to be used consistent with Original Medicare (specific CPT codes not listed in this document).

Policy Summary

PayerBlue Cross Blue Shield - Michigan

PolicyRoutine hepatitis C screening

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit claims with CPT/HCPCS and diagnosis codes to highest specificity on CMS-1500, UB-04 or 837 and collect applicable member cost-sharing at time of service.

SourceLink

On This Page

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Coverage Authorization and Payment Conditions

Billing Rule

Coverage authorization and payment conditions — Provider actions

Enhanced coverage for routine hepatitis C screening is available for members under select Medicare Plus Blue Group PPO plans. Providers should follow Original Medicare rules for eligibility, billing location, frequency, CPT coding, and age restrictions; however, diagnosis restrictions may apply per the group. Confirm member's group-specific cost-sharing and coverage conditions before providing services.

Follow Original Medicare rules for: eligible provider, payable location, frequency, CPT codes, and age restrictions.
Diagnosis restrictions may limit payment — verify applicable group-specific restrictions.
Confirm member's group (Medicare Plus Blue Group PPO) enhanced benefit applicability and cost-sharing prior to service.
Bill using the CPT codes consistent with Original Medicare screening guidance; document screening intent.
Providers should verify authorization requirements with the member's group plan if unclear.

OpenPayer

Routine hepatitis C screening

Coverage Criteria for Routine Hepatitis C Screening

Coding and Frequency

Coverage Authorization and Payment Conditions

Definitions