Traditional MedicareCoverageMedium impact
Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
Medicare/CMS - NCD·Infectious Disease, Internal Medicine, Family Medicine·National Coverage Determination
We identified it
Oct 2, 2026
Summary
This is a National Coverage Determination (NCD 190.13) for HIV testing related to prognosis and monitoring. However, the provided policy content contains only metadata and does not include the actual policy details, coverage rules, billing codes, or effective date information needed for billing team action.
Action Required
URGENT: Billing team must obtain the full policy text from the CMS Medicare Coverage Database at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=46&ncdver=1 to determine: (1) which HIV testing CPT/HCPCS codes are covered, (2) any prior authorization requirements, (3) frequency limitations, (4) documentation requirements, and (5) the official effective date. Do not implement billing changes until the complete policy details are reviewed. Flag this policy for review by compliance and clinical leadership before updating billing workflows.