CMS recommends hepatitis C screening for some beneficiaries

March 26, 2014

The Centers for Medicare and Medicaid Services (CMS) is accepting public comments until April 3 on its new hepatitis C screening guidelines.

The Centers for Medicare and Medicaid Services (CMS) is accepting public comments until April 3 on its new hepatitis C screening guidelines.

“The evidence is adequate to conclude that screening for hepatitis C virus (HCV), consistent with the grade B recommendations by the U.S. Preventive Services Task Force (USPSTF), is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B,” according to CMS’s Proposed Decision Memo for Screening for Hepatitis C Virus (HCV) in Adults.

Beneficiaries who meet either of the following conditions should receive the test, according to CMS:

1. A screening test is covered for adults at high risk for HCV infection. “High risk” is defined as persons with a current or past history of illicit injection drug use; and persons who have a history of receiving a blood transfusion prior to 1992. Repeat screening for high-risk persons is covered annually only for persons who have had continued illicit injection drug use since the prior negative screening test.

2. A single screening test is covered for adults who do not meet the high risk as defined above, but who were born between 1945 and 1965.

 

 

Because up to three quarters of HCV-infected individuals are unaware of their status, screening for HCV infection could identify persons at earlier stages of disease, “before they develop serious or irreversible liver damage, and lead to treatments to improve clinical outcomes or reduce transmission risk,” the CMS memo stated.

The Centers for Disease Control and Prevention (CDC) recommends that HCV testing be initiated with an FDA-approved test for antibody HCV followed by an HCV nucleic acid test (NAT) for persons who test positive. Meanwhile, the USPSTF found that anti-HCV antibody testing followed by polymerase chain reaction testing (a type of NAT) is accurate for identifying patients with chronic HCV infection.

Comments can be submitted via the CMS’s Proposed Decision Memo for Screening for Hepatitis C Virus (HCV) in Adults page.