2025 HCPCS code G0435
(Active) Effective Date: N/A Revision Date: N/A Laboratory Services - Infectious Disease Screening Laboratory Screening Tests Feed
Infectious agent antibody detection by rapid antibody test for HIV-1 and/or HIV-2 screening.
Modifiers may be applicable depending on the specific circumstances of service. Consult current modifier guidelines.
Medical necessity is typically established by the patient's risk factors for HIV infection, including sexual behavior, intravenous drug use, exposure to HIV-positive individuals, or pregnancy.Pregnant women are routinely screened for HIV as per public health guidelines.
The clinical responsibility involves obtaining a sample (blood or oral fluid) from the patient, performing the rapid antibody test, interpreting the results, and counseling the patient about the implications of the results.If positive, the provider is responsible for ordering and interpreting confirmatory testing to diagnose HIV infection.
In simple words: This code is for a quick test to check if someone might have HIV. It uses a blood or saliva sample and gives results in about 20 minutes.A positive result doesn't confirm HIV; further tests are needed.
This HCPCS code, G0435, represents the performance of a rapid antibody test to screen for the presence of HIV-1 and/or HIV-2 antibodies.The test uses a sample of body fluid, typically blood or oral fluid, and provides results within approximately 20 minutes. A positive result indicates the presence of antibodies, suggesting potential HIV infection, but requires confirmatory testing for diagnosis.
Example 1: A patient presents to a clinic expressing concerns about potential HIV exposure. The provider orders and performs a rapid HIV antibody test (G0435). The result is negative, reassuring the patient. , A pregnant woman undergoes routine HIV screening during her prenatal care. A rapid HIV antibody test (G0435) is performed, and the result is positive. The provider orders confirmatory testing and initiates appropriate counseling and treatment., An individual at high risk for HIV infection seeks testing at a public health clinic. A rapid HIV antibody test (G0435) is performed as part of a comprehensive HIV screening protocol. The result is negative, but the provider emphasizes the importance of continued safe sexual practices.
* Patient demographics and identification information* Indication for testing (risk factors, symptoms, pregnancy, etc.)* Date and time of specimen collection* Method of specimen collection (blood, oral fluid)* Test result (positive/negative)* Date and time of test result reporting* Provider signature and credentials* If positive, documentation of confirmatory testing and patient counseling
** Medicare covers this test once a year for beneficiaries at increased risk and up to three times during pregnancy, if clinically indicated.Positive results require confirmatory testing using more sensitive methods.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Infectious Disease, Internal Medicine, Family Medicine, Obstetrics/Gynecology
- Place of Service:Office, Clinic, Hospital, Public Health Clinic