Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
NCD53
Medicare covers diagnostic HIV testing when there is strong clinical suspicion based on documented opportunistic infections, STIs, hepatitis B/C, AIDS-related neoplasms or neurologic conditions, unexplained systemic symptoms or laboratory evidence of immune deficiency, acute retroviral syndrome, known blood/body-fluid exposure (including needlesticks), or sexual assault/rape. Serologic EIA-based testing (HIV-1 or HIV-1/2 combinations) is the usual method; Western Blot is reserved for confirmation after repeatedly positive or equivocal EIA results, and direct viral RNA/culture/DNA testing is appropriate when serology is inconclusive (e.g., acute or perinatal infection). If serology confirms infection, no repeat testing is indicated; if EIA is negative and RNA testing is not indicated, retesting is recommended at 3–6 months.
"Diagnostic HIV testing is indicated for patients with a documented, otherwise unexplained, AIDS-defining or AIDS-associated opportunistic infection."