Screening for the Human Immunodeficiency Virus (HIV) Infection

Effective January 1, 2009, CMS is allowed to add coverage of "additional preventive services" if certain statutory requirements are met, as provided under section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). Among other things, this new benefit allows CMS under 42 CFR 410.64 to cover "additional preventive services", if it determines through the NCD process that the service is recommended with a grade A (strongly recommends) or grade B (recommends) rating by the United States Preventive Services Task Force (USPSTF) and meets certain other requirements.

As of December 2009, and based on the 2007 USPSTF recommendations in conjunction with studies and guidelines published at that time, CMS covers both standard and FDA-approved HIV rapid screening tests for: (1) annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines, and (2) voluntary HIV screening of pregnant Medicare beneficiaries when the diagnosis of pregnancy is known, during the third trimester and at labor. Section 210.7 of the Medicare National Coverage Determinations (NCD) Manual establishes conditions of coverage for screening for the Human Immunodeficiency Virus (HIV) infection.

In April 2013, the USPSTF revised its Grade "A" recommendation for routine HIV screening to cover all adolescents and adults ages 15 to 65 years, without regard to perceived risk behavior. The grade "A" recommendation also covers those outside this age range who are at increased risk for infection. The HIV Testing Reimbursement Working Group, a sub-group of the HIV Healthcare Access Working Group and the Federal AIDS Policy Partnership, submitted an NCD reconsideration request asking CMS to review new scientific evidence and to adopt the USPSTF's most current evidence-based recommendations.

August 4, 2014

January 29, 2015

April 13, 2015