Medicare to Cover Hepatitis C Screening

Screening for the hepatitis C virus (HCV) will now be covered by Medicare, according to a new ruling by the secretary of Health and Human Services and CMS. According to the Social Security Act, the secretary may add additional preventive services if she determines they are reasonable and necessary, appropriate for Medicare beneficiaries and are recommended with a grade A or B by the United States Preventive Services Task Force. The secretary must use the process for developing national coverage determinations (NCDs) when determining if a test should be covered for a screening purpose. To be covered, the tests must be ordered a primary care practitioner in a primary care setting like a physician office. The test used must be approved by the U.S. FDA and must be performed in a laboratory appropriately licensed under CLIA. The patient must be considered high risk for HCV as defined in the NCD or, in the absence of any signs, symptoms or pertinent medical history, a person may receive one HCV test if they were born from 1945 to 1965, people who are between 49 and 69 years old now. This NCD has the potential to increase the number and kind of hepatitis tests laboratories perform. The NCD does not specify any particular test for screening, but says initial testing for HCV should be performed using the most sensitive immunoassays licensed for detection of antibody to HCV (anti-HCV) in blood. Laboratories should be aware of the laws and regulations concerning providing beneficiary inducements to direct tests to their lab instead of others and to make certain they are using an appropriate test for screening, not one based on financial benefits to the laboratory. The NCD can be found www.cms.gov