Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AetnaAll Plans · Coverage · Medical Policy · Infectious Disease, Internal MedicineMedium impact

HIV Testing (CPB 0542, reviewed 2025-11-26)

Effective date
Not stated in the notice
Identified
Aug 18, 2026

Summary

Aetna considers HIV testing medically necessary for screening according to the recommendations of the U.S. Preventive Services Task Force and the CDC. Initial testing uses an FDA-approved antigen/antibody combination immunoassay, and further testing follows only for reactive results. Aetna does not cover home HIV test kits that do not require a physician's prescription under any plan, including the Confide Home HIV Test and the Home Access HIV Test System.

Get alerts when payers change rules like this one

We check Aetna and other payers every day and email you when a change matches your specialty and state.

Get Aetna alertsPolicy Monitoring is free. No card required.

What to do

Action · 6 steps
01Billing team: Bill the HIV testing codes only when the selection criteria are met.
02The policy lists CPT 86689, 86701, 86702, 86703, 87389, 87390, 87391, 87534, 87535, 87536 and 87806, HCPCS G0432, G0433, G0435, G0475 and S3645, and ICD-10 codes B20, Z11.4, Z20.6, Z20.828 and Z21 as covered if the criteria are met.
03No further testing is required for specimens that are nonreactive on the initial immunoassay.
04Do not bill home HIV test kits that do not require a physician's prescription, such as the Confide Home HIV Test or the Home Access HIV Test System, because the policy does not cover them under any plan.
05The OraSure oral HIV test kit may be used for the same indications as standard HIV testing.
06The OraQuick Rapid HIV-1 Antibody point-of-care test is an adequate alternative to laboratory HIV blood tests for medically necessary indications.

Codes mentioned

8668986701867028670387389873908739187534875358753687806G0432G0433G0435G0475S3645B20Z11.4Z20.6Z20.828Z21

Original notice

HIV Testing (CPB 0542, reviewed 2025-11-26)
aetna.com · Always check the source before changing claims.
View original ↗

Related changes

See all Aetna changes →
HIV Testing (CPB 0542, reviewed 2026-08-28)MediumNo effective date · Medical PolicyMarnetegragene Autotemcel (Kresladi) (CPB 1102)MediumNo effective date · Medical PolicyMarnetegragene Autotemcel (Kresladi) (CPB 1102, reviewed 13-2026-07)MediumNo effective date · Medical PolicyElivaldogene Autotemcel (Skysona) (CPB 1017, reviewed 2026-04-08)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesInfectious DiseaseInternal MedicineCode 86689Code 86701Code 86702Code 86703Code 87389Code 87390Code 87391Code 87534Code 87535Code 87536Code 87806Code G0432Code G0433Code G0435Code G0475Code S3645Code B20Code Z11.4Code Z20.6Code Z20.828Code Z21

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account