NCD190.9

 

SEROLOGIC TESTING FOR ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

 

Effective Date of this Version

• 8/12/1987

 

Benefit Category

• Diagnostic Laboratory Tests.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

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)."

o 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).

o When an assay is reactive on initial testing, it should be repeated on the same specimen.

o A more specific test, (Western blot, immunofluorescent assay) is usually performed following repeatedly reactive ELISA results.

 

Indications and Limitations of Coverage

• These tests may be covered when performed to help determine a diagnosis for symptomatic patients.

o 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.

 

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