Part B Insider (Multispecialty) Coding Alert

HIV "high risk" factors:

HIV "high risk" factors:

  • Men who have had sex with men after 1975
  • Men and women having unprotected sex with multiple [more than one] partners
  • Past or present injection drug users
  • Men and women who exchange sex for money or drugs, or have sex partners who do
  • Individuals whose past or present sex partners were HIV-infected, bisexual, or injection drug users
  • Persons being treated for sexually transmitted diseases
  • Persons with a history of blood transfusion between 1978 and 1985
  • Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors.

Source: CMS's Decision Memo on HIV screening, available at www.cms.gov/mc/viewdecisionmemo.asp?id=229.