Serologic Testing for Acquired Immunodeficiency Syndrome (AIDS)

CMS National Coverage Determination | ncd_id=265 | manual_section=190.9 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False

These tests may be covered when performed to help determine a diagnosis for symptomatic patients. They are not covered when furnished as part of a screening program for asymptomatic persons. NOTE : Two enzyme-linked immunosorbent assay (ELISA) tests that were conducted on the same specimen must both be positive before Medicare will cover the Western blot test.

Item/Service Description: Serologic testing is employed to detect antibodies to the AIDS virus, which is currently identified by the term "human immunodeficiency virus (HIV)." The virus originally was named "human T-cell lymphotropic virus, type III (HTLV-III), a term that remains in common usage. Antibodies may be detected by a variety of immunoassay techniques, the most common being an enzyme linked immunosorbent assay (ELISA). When an assay is reactive on initial testing, it should be repeated on the same specimen. A more specific test, (Western blot, immunofluorescent assay) is usually performed following repeatedly reactive ELISA results. Revision History: 07/1987 - Provided coverage when needed to help determine a diagnosis for symptomatic patients and coverage when furnished as part of a screening program for asymptomatic people. Effective date 08/12/1987. (TN 17) Benefit Categories: 18 - Diagnostic Laboratory Tests Transmittal: transmittal_number=33 | transmittal_issue_date=1987-07-01