Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs

CMS covers screening for chlamydia, gonorrhea, syphilis, and hepatitis B and high-intensity behavioral counseling (HIBC) consistent with USPSTF A/B recommendations when tests are FDA-approved/CLIA-compliant and services are ordered and delivered by eligible primary care providers in primary care settings. Specific covered populations include pregnant women (with timing and repeat screens specified), women and men at increased risk (generally annual screening), and all sexually active adolescents or adults at increased risk for HIBC; HIBC is limited to two 20–30 minute sessions annually and requires referral by a primary care practitioner. Preventive services not explicitly covered by this NCD (or other NCD/statute) are non-covered, and documentation must record sexual history, ordering provider, and counseling content.

"Medicare covers screening for chlamydia, gonorrhea, syphilis, and hepatitis B consistent with USPSTF A/B recommendations using FDA-approved/cleared laboratory tests performed in CLIA-compliant labs..."