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CMS Announces that Medicare Will Cover HCV Screening

June 4, 2014
CMS Announces that Medicare Will Cover HCV Screening

On Monday, June 2, the Centers for Medicare & Medicaid Services (CMS) announced that it will cover screening for hepatitis C virus (HCV) infection. Previously in 2012, the US Centers for Disease Control and Prevention (CDC) also recommended that all Baby Boomers, those born between 1945 and 1965, should have a one-time blood test to screen for HCV, which often goes undetected and can take years to cause serious illness. Untreated, HCV can eventually cause liver disease and liver cancer.

In its National Coverage Determination, CMS observed that “the evidence is adequate to conclude that screening for Hepatitis C Virus (HCV), consistent with the grade B recommendations by the U.S. Preventive Services Task Force (USPSTF), is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under [Medicare] Part A or enrolled under Part B.”

CMS will cover HCV screening with the appropriate US Food and Drug Administration (FDA) tests when ordered by the beneficiary’s primary care physician at a primary care setting. But the beneficiary must meet one of these conditions:

  1. A screening test is covered for adults at high risk for HCV infection. “High risk” is defined as those with a current or past history of illicit injection drug use; and people who have a history of receiving a blood transfusion prior to 1992. Repeat screening for high-risk people is covered annually only for those who have had continued illicit injection drug use since the prior negative screening test
  2. A single screening test is covered for adults who do not meet the high risk definition, but who were born from 1945 through 1965.

This significant development will aid in nationwide efforts to improve hepatitis diagnosis, care and treatment detailed in the updated Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (2014-2016),” observed Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases. “We encourage all stakeholders to join in raising awareness about the CMS decision among both healthcare providers and Medicare beneficiaries who may benefit from an HCV screening, particularly those born between 1945 and 1965 who comprise more than 75 percent of people with hepatitis C in the United States.”

Read the full decision memo on the CMS website.