Last Updated on January 25, 2020 by

In recognition of Hepatitis Testing Day, May 19, The AIDS Institute has released a Hepatitis C (HCV) Testing Coverage Guide to assist health care providers with navigating each of the major healthcare payers’ coverage options for preventive services, specifically for HCV screening. Additionally, the guide will help educate people on the need to get tested for hepatitis and that cost of the test should not be a deterrent.

Access the coverage guide here.

Last year, the United States Preventive Services Task Force (USPSTF) recommended adding one time testing of “baby boomers” – those born between 1945 and 1965 – to their current “B” grade recommendation of screening for those at high risk of HCV infection. This is an important step for HCV screening because under the Affordable Care Act (ACA), the major payers, such as Medicaid, Medicare and private insurers, are required or heavily incentivized to cover the costs of screening for those services rated with grades A and B.

“This coverage guide is a useful tool for understanding how the recently revised recommendations by the USPSTF on hepatitis C screening will impact coverage by Medicaid, Medicare and private insurance as a result of the ACA,” explained Carl Schmid, Deputy Executive Director of The AIDS Institute.

It is estimated that about 3.2 million people are living with chronic Hepatitis C (HCV) infection in the United States, and the number of new annual infections remains steady at approximately 17,000. For those with chronic infection, HCV can result in serious health problems, such as cirrhosis of the liver or even death. Nearly half of those living with HCV are unaware of their infection because they do not feel sick.

“By reducing or removing cost barriers to screening, we are confident that more people will be tested and ultimately brought into care and treatment for their HCV, which now can be a curable disease,” said Schmid.

The USPSTF grade change acknowledges the benefits of screening the “baby-boomer” population, which represents more than 75% of HCV cases in the United States, while also aligning with the Centers for Disease Control and Prevention guidance. It also reconfirms that other “high risk” individuals, no matter their age, should also be tested.

“The AIDS Institute encourages medical providers to implement the USPSTF recommendation and offer HCV testing to their baby boomer and high-risk patients,” stated Michael Ruppal, Executive Director, The AIDS Institute. “As we have demonstrated with this coverage guide, thanks to the ACA, preventive services, such as HCV screening, can be reimbursed by the major payers. While there is still work to be done particularly as it relates to Medicaid at the state level, providers, clinics and health departments should develop billing systems and take advantage of the reimbursement opportunities for HCV screening. As a result, we believe more people will be brought into care and their hepatitis can be properly treated,” said Ruppal.

Additional Resources:

OraSure Reimbursement Guidelines

List of Community Testing Programs in NYC

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