UHC Commercial Policy – Hepatitis Screening Update

Effective 10/1/2021 Updated:

Applicable Codes Revised description for CPT code 87350 Updated list of ICD-10 diagnosis codes:

•  Added:

B00.81, O35.7XX0, O35.7XX1, O35.7XX2, O35.7XX3, O35.7XX4, O35.7XX5, O35.7XX9, O36.8210, O36.8211, O36.8212, O36.8213, O36.8214, O36.8215, O36.8219, O36.8220, O36.8221, O36.8222, O36.8223, O36.8224, O36.8225, O36.8229, O36.8230, O36.8231, O36.8232, O36.8233, O36.8234, O36.8235, O36.8239, O36.8290, O36.8291, O36.8292, O36.8293, O36.8294, O36.8295, O36.8299, O94, P58.41, P78.81, P78.84, R78.2, T74.21XS, T76.21XS, T76.22XS, Z03.71, Z03.72, Z03.73, Z03.74, Z03.75, Z03.79, Z04.81, Z29.13, Z32.2, Z36.0, Z36.1, Z36.4, Z36.5, Z36.81, Z36.82, Z36.83, Z36.84, Z36.85, Z36.86, Z36.87, Z36.88, Z36.8A, and Z76.82

• Removed:

A34, B15.0, B15.9, B16.0, B16.1, B16.2, B16.9, B17.0, B17.2, B17.8, B17.9, B18.0, B18.1, B18.8, B18.9, B19.0, B19.10, B19.11, B19.9, F12.10, F12.11, F12.13, F12.120, F12.121, F12.122, F12.129, F12.150, F12.151, F12.159, F12.180, F12.188, F12.19, F12.20, F12.21, F12.220, F12.23, F12.250, F12.251, F12.29, F12.93, F18.10, F18.11, F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, F18.17, F18.180, F18.188, F18.19, F18.20, F18.21, F18.220, F18.229, F18.250, F18.251, F18.259, F18.29, N76.0, N76.1, N76.2, N76.3, N77.1, W46.1XXA, W46.1XXD, Z20.821, and Z33.2 o Revised description for O32.9XX0, O69.0XX1, and O74.7

Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/index/commercial/hepatitis-screening-10012021.pdf