PEHTI offers guidance and technical support on health insurance coverage and/or reimbursement/billing (if fee-for-service) for routine HIV screening in healthcare settings (i.e. incl. managed care documentation of fulfillment of standard-of-care for preventive services and billing codes for services provided under fee-for-service health insurance). The following reference documents provide guidance:
- USPSTF Grade A recommendations for opt-out HIV screening as a basis for inclusion of opt-out HIV screening in the managed care preventive care package or reimbursement/billing in the context of fee-for-service coverage.
- Coding guide for routine HIV testing in health care settings (AMA/AAHIVMA)
- For managed care coverage of routine HIV screening, it is important to note that the 2013 USPSTF Grade A recommendations place HIV screening firmly within the scope of preventive services that are typically included in capitated allocations for managed care. Notwithstanding, PEHTI recognizes the major transitions underway in the healthcare coverage landscape vis-a-vis ACA and other attendant issues, and will work with partners towards obtaining clarification of the positions of managed care health insurers pursuant to the 2013 Grade A recommendation of HIV screening (by the USPSTF).
To effectively direct opt-out HIV screening across various settings, it is necessary to monitor services, expenditure/health coverage costs, and evaluate outcomes of services including assessment of the cost-effectiveness and cost-benefit thereof.