Dive Brief:
- Medicare will cover screening for hepatitis C virus in adults, CMS said in a June 2 decision memo. The federal program will pay for screening tests for beneficiaries at high risk for the contagious liver infection, and for baby boomers born from 1945 through 1965.
- Medicare only will pay for screening with approved lab tests ordered by the beneficiary's primary care physician or practitioner in a primary care setting.
- Medicare won't cover hepatitis C screenings in emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehab facilities, clinics "providing a limited focus of health care services," and hospice.
Dive Insight:
CMS, in its national coverage determination, says preventive services should be provided in a coordinated manner within the context of the patient’s total health-care needs. CDC estimates that 3.2 million people in the U.S. have chronic hepatitis C and are unaware of their condition, and about 17,000 Americans become infected with it annually. Given the size of this public health problem, even if PCPs are "at the front lines," as CMS asserts, why not extend coverage into the hospital setting and beyond if it means more people will have access to this important preventive service?
