Acute Hepatitis Panel / Hepatitis Panel
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ACUTE HEPATITIS PANEL / HEPATITIS PANEL
NCD
Hepatitis B Surface Antigen (HbsAg)
Hepatitis C Antibody
Hepatitis B Core Antibody (HbcAb), IgM Antibody
Hepatitis A Antibody (HAAb), IgM Antibody
Source: Program Memorandum AB-02-110, Effective 11-25-02; Medicare NCD Manual, July 2003
Release, July 2005 Release, April 2006 Release, October 2006 Release; Medicare Trans. 1531, Effective
7-1-08, October 2008 Release, October 2009 Release, October 2010 Release
CMS (Medicare) has determined that Acute Hepatitis Panel / Hepatitis Panel (CPT Code 80074) is only
medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the
diagnostic conditions listed below in the “ICD-9-CM Codes Covered by Medicare Program.” If you are
ordering this test for a diagnostic condition other than those listed below, please have your patient sign
and date an Advanced Beneficiary Notice (ABN). All ICD-9-CM codes provided must be consistent with
the documentation in the patient’s medical records for the date of service.
NOTE: Please be aware that it is not enough to link the procedure code to a correct, payable ICD-9-CM
diagnosis code. The diagnosis must be present for the procedure to be paid. In addition, the procedure
must be reasonable and necessary for that diagnosis. Documentation within the beneficiary's medical
record must support the necessity for the test(s) provided for each date of service. For additional
information, see the “Limited Coverage Guidebook Information” provided in this section.
Covered ICD-9-CM Codes by Medicare Program:
070.0-070.1
Viral hepatitis- hepatitis A with or without mention of hepatic coma
070.20-070.59
Viral hepatitis- Hepatitis B with or without mention of hepatic coma, other specified
viral hepatitis with or without mention of hepatic coma
070.6
Unspecified viral hepatitis with hepatic coma
070.70-070.71
Unspecified viral hepatitis C
070.9
Unspecified viral hepatitis without mention of hepatic coma
456.0-456.21
Esophageal varices with or without mention of bleeding
570
Acute and subacute necrosis of liver
571.5
Cirrhosis of liver without mention of alcohol
572.0-572.8
Liver abscess and sequelae of chronic liver disease
573.3
Hepatitis, unspecified
780.31
Febrile convulsions
780.32
Complex febrile convulsions
*780.33
Post traumatic seizures
780.71
Chronic fatigue syndrome
780.72
Functional quadriplegia
780.79
Other malaise and fatigue
782.4
Jaundice, unspecified, not of newborn
783.0-783.1
Symptoms concerning nutrition, metabolism, and development- anorexia, abnormal
weight gain
783.21.783.22
Abnormal loss of weight and underweight
783.3
Feeding difficulties and mismanagement
783.40-783.43
Lack of normal physiological development, unspecified
783.5-783.6
Polydipsia, polyphagia
787.01-787.03
Nausea and vomiting
787.04
Bilious emesis
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Acute Hepatitis Panel / Hepatitis Panel
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789.00-789.09
789.1
789.61
789.7
790.4
794.8
996.82
V72.85
Abdominal pain
Hepatomegaly
Localized abdominal tenderness (RUQ)
Colic
Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH)
Nonspecific abnormal results of function
Complications of transplanted organ, liver
Liver transplant recipient evaluation
ICD-9-CM Codes That May Be Denied or Do Not Support Medical Necessity
Generally, ICD-9-CM codes that are not listed in the “ICD-9-CM Codes Covered by Medicare Program”
section will not be covered because they indicate that the tests are performed for screening purposes or
because they do not support medical necessity.
Frequency Limitations:
After a hepatitis diagnosis has been established, only individual tests, rather than the entire panel, are
needed.
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