Traditional MedicareCoverageMedium impact
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
Medicare/CMS - NCD·Infectious Disease, Family Medicine, Internal Medicine +1 more·National Coverage Determination
We identified it
Oct 2, 2026
Summary
This is a National Coverage Determination (NCD 190.14) for HIV Testing (Diagnosis) that was last updated on October 1, 2026. The policy establishes Medicare coverage parameters for HIV diagnostic testing as a laboratory service. Without access to the specific policy content comparing this to prior versions, the billing team should obtain the full policy document to identify what coverage criteria, testing methodologies, or billing requirements have changed.
Action Required
Immediately: Billing team must obtain and review the full text of NCD 190.14 from the CMS Medicare Coverage Database at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=53&ncdver=3. Identify any changes to covered HIV testing methodologies, frequency limitations, or documentation requirements. Update billing software and encounter forms to reflect any new coverage restrictions or required modifiers. Communicate changes to providers in infectious-disease, family-medicine, internal-medicine, and emergency-medicine departments. Verify whether prior authorization is now required for HIV testing claims. Train front-desk and billing staff on any new patient eligibility verification requirements before submitting claims. Claims submitted without compliance to updated requirements will be denied.