CommercialCoverageMedium impact
Hepatitis Screening (CPB 0835, reviewed 2025-12-09)
Aetna·Infectious Disease, Internal Medicine, Family Medicine +4 more·Medical Policy
Effective date
Dec 9, 2025
We identified it
Aug 17, 2026
Summary
Aetna updated its Hepatitis Screening policy (CPB 0835) effective 2025-12-09, establishing specific medical necessity criteria for HBV, HCV, and HDV screening across defined risk populations. The policy now covers one-time HCV screening for all adults aged 18+, while HEV screening remains experimental/investigational. Billing teams must verify patient eligibility against the detailed criteria before submitting claims using the specified CPT, HCPCS, and ICD-10 codes.
Action Required
By 2025-12-09, the billing team must: (1) Update billing system rules to require verification that patients meet Aetna's medical necessity criteria for hepatitis screening before claim submission; (2) For HBV screening (CPT 86704, 86705, 86706, 87340, 87341, HCPCS G0499), verify patient belongs to one of the specified high-risk categories (hemodialysis, healthcare workers with exposure, HIV+, injection drug users, pregnant women, etc.); (3) For HCV screening (CPT 86803, 86804, HCPCS G0472), note that one-time screening is now medically necessary for ALL adults 18+, not just high-risk groups; (4) For HDV screening (CPT 86692), confirm patient is HBsAg-positive AND meets ALL four risk factors: IV drug user status, HBV-DNA <2,000 IU/ml, ALT >40 U/L, and HDV endemic country origin; (5) Add documentation requirement fields to encounter forms requiring providers to document which specific criteria are met; (6) Do NOT bill CPT codes for HEV (hepatitis E) screening, as it remains experimental/investigational; (7) Map appropriate ICD-10 codes from the policy's coverage list to each claim. Claims submitted without documented medical necessity meeting these criteria will be denied by Aetna.