Medicare Approves Hepatitis C Testing for Baby Boomers

June 4, 2014
Catherine Kolonko

Internal Medicine World Report, June 2014,

People from the Baby Boom generation covered under Medicare can now get one-time screening for hepatitis C, according to a memo from the Centers for Medicare & Medicaid Services.

People from the Baby Boom generation covered under Medicare can now get one-time screening for hepatitis C, according to a memo from the Centers for Medicare & Medicaid Services (CMS).

The Centers for Disease Control and Prevention (CDC) has recommended testing of all so called baby boomers born from 1945 to 1965. It’s a population which has roughly five times higher prevalence of the bloodborne virus than other adults, in part because blood supplies were not screened for hepatitis C until some time after the virus was discovered in 1989, according to Dr. John Ward, Director for the Division of Viral Hepatitis at the CDC.

“They were young and had multiple risks before the virus was discovered and prevention measures like screening the blood supply were put in place, which has lowered the number of new infections,” Ward said in a recent interview about high-risk baby boomers.

Chronic infection of hepatitis C affects an estimated 3 million people nationwide and 130 million to 150 million people across the globe. Health officials have called hepatitis C a silent epidemic because the virus can remain in a person’s body for decades without symptoms. If left unchecked it can lead to cirrhosis and liver cancer and is the most common cause of liver transplants in the United States.

A memo outlining the coverage decision from CMS states that there is adequate evidence to conclude that screening for hepatitis C “is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B…” The ruling is consistent with recommendations by the U.S. Preventative Services Task Force, which endorses no cost hepatitis C screening for at risk patients, officials noted in the memo.

Medicare requires that testing for the virus fall under the order of a primary care physician or practitioner and be performed by an eligible Medicare provider. It must be conducted with FDA approved laboratory tests under approved labeling and in compliance with Clinical Laboratory Improvement Act (CLIA) regulations, the memo states.

Coverage also includes a hepatitis C screening test for other adults who fall under the high risk category, those with a current or past history of illicit injection drug use or have a history of receiving a blood transfusion before 1992. In addition, coverage is also extended for repeat screening only for people considered high risk because of continued illicit injection drug use since a prior negative screening test, according to the memo.

National coverage determinations only cover Medicare enrollees and not private insurance, said CMS spokesman Don McLeod, who noted that the decision covers testing only and not treatment for those determined to be positive for the virus. McLeod could not provide an estimated annual cost to Medicare for approved screenings.