Hepatitis Screening — CPB 0835 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0835 covering hepatitis screening, effective December 10, 2025. Here's what billing teams need to know about the updated criteria for HBV, HCV, and HDV screening across CPT codes 86692, 86704, 86705, 86706, 86803, 86804, 87340, and 87341, plus HCPCS G0472 and G0499.

This Aetna hepatitis screening coverage policy update clarifies medical necessity criteria across three hepatitis types — B, C, and D — and adds explicit guidance on HDV screening for HBsAg-positive patients. If your practice sees high-risk populations, does prenatal care, manages HIV patients, or serves hemodialysis centers, this update directly affects your claim submission workflow. The policy also draws a hard line on hepatitis E screening in the peri-transplant period, calling it experimental — which means claim denials are coming if you haven't already flagged that.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Hepatitis Screening
Policy Code	CPB 0835
Change Type	Modified
Effective Date	December 10, 2025
Impact Level	Medium
Specialties Affected	Gastroenterology, Infectious Disease, Obstetrics, Nephrology, Internal Medicine, Primary Care, Laboratory
Key Action	Audit your hepatitis screening claims against the updated indication lists for HBV, HCV, and HDV before submitting under CPT 86692, 86704, 86706, 86803, 87340, or 87341

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Aetna Hepatitis Screening Coverage Criteria and Medical Necessity Requirements 2025

The Aetna hepatitis screening coverage policy under CPB 0835 covers screening for HBV, HCV, and HDV — but only when specific patient-level criteria are met. This is not blanket coverage. Every claim needs a documented indication.

Hepatitis B (HBV) Screening

Aetna considers HBV screening medically necessary for 14 defined populations. These include current or former hemodialysis patients, blood and organ donors, household or sexual contacts of known HBV-positive individuals, and people born in regions with 2% or higher chronic HBV prevalence — including Asia, Africa, and other high-endemicity areas.

The policy also covers infants born to HBV-infected mothers, injection drug users, men who have sex with men, and individuals with HIV. Pregnant women are covered, as are persons needing immunosuppressive therapy — including chemotherapy, organ transplant immunosuppression, and immunosuppression for rheumatologic or gastroenterologic conditions.

Two criteria deserve extra attention. First, individuals with chronically elevated ALT or AST of unknown etiology qualify for HBV screening. Second, U.S.-born persons who were not vaccinated as infants qualify if their parents were born in regions with HBV endemicity of 8% or higher — including sub-Saharan Africa, southeast and central Asia, and China. Bill HCPCS G0499 or CPT 87340 (HBsAg) and 86704 (HBcAb) for these cases with a supporting ICD-10 tied to the qualifying indication.

Hepatitis C (HCV) Screening

HCV medical necessity criteria cover 12 populations under this coverage policy. They include injection drug users, individuals with HIV, current or former hemodialysis patients, and pregnant women. The policy also covers children born to HCV-infected mothers and children from high-prevalence regions.

Patients who received blood transfusions or organ transplants before July 1992 qualify, as do those who received blood from a donor who later tested positive for HCV. Patients who got clotting factor concentrates produced before 1987 are also covered. Present sexual partners of HCV-infected persons and individuals with persistently abnormal ALT levels are covered as well.

Healthcare workers, emergency medical personnel, and public safety workers qualify after needlestick, sharps, or mucosal exposures to HCV-positive blood. Bill CPT 86803 or HCPCS G0472 for these occupational exposure cases, consistent with how similar HBV exposure criteria are billed.

One-time HCV testing without prior risk ascertainment is medically necessary for all adults 18 and older. This is a broad coverage provision. It means you don't need a documented risk factor to bill CPT 86803 or HCPCS G0472 for an adult patient getting a one-time screen. That's a meaningful reimbursement opportunity if your team hasn't been capturing it. Whether prior authorization is needed for one-time universal screening varies by plan — check the member's specific benefit before assuming clean claims.

Hepatitis D (HDV) Screening

This is where the policy gets specific. Aetna considers HDV screening medically necessary for patients who are already HBsAg-positive and who have significant risk factors. The policy characterizes those risk factors as including intravenous drug use, HBV-DNA below 2,000 IU/mL, ALT above 40 U/L, and origin from an HDV-endemic country.

That's a narrow population. Ensure the patient chart documents HBsAg-positive status and the relevant risk factors before billing CPT 86692. Thin documentation on any of these factors is an audit risk.

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Aetna Hepatitis Screening Exclusions and Non-Covered Indications

Aetna considers hepatitis E virus (HEV) screening in the peri-transplant period experimental, investigational, or unproven. There are no CPT or HCPCS codes listed as covered for HEV screening under this policy.

If your transplant team has been ordering HEV screening pre- or post-transplant and billing under a general infectious agent code, expect a claim denial. The policy states that the effectiveness of this approach has not been established. Document this as a non-covered service for Aetna members and route accordingly.

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Coverage Indications at a Glance

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Aetna Hepatitis Screening Billing Guidelines and Action Items 2025

These steps apply to any practice, lab, or health system submitting hepatitis screening claims under Aetna CPB 0835 after the effective date of December 10, 2025.

Copy Action Items

If your patient mix includes a high volume of hemodialysis patients, prenatal cases, or HIV-positive individuals, review your standing order sets against the updated criteria. Talk to your compliance officer if you're unsure how the HDV criteria apply to your specific population — the documentation burden is real, and Aetna's language on qualifying risk factors is specific.

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CPT, HCPCS, and ICD-10 Codes for Hepatitis Screening Under CPB 0835

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
G0472	HCPCS	Hepatitis C antibody screening for individual at high risk and other coverage indication(s)
G0499	HCPCS	Hepatitis B screening in non-pregnant, high risk individual; includes hepatitis B surface antigen (HBsAg)

Key ICD-10-CM Diagnosis Codes

The full ICD-10-CM list under CPB 0835 includes 510 codes. The codes above represent the highest-volume indications for most billing teams. Access the complete list at the CPB 0835 policy source.

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