Does Medicare cover STI screening?

What STI screenings does Medicare cover?

Medicare Part B covers screenings for chlamydia, gonorrhea, syphilis and/or hepatitis B. STI screenings and counseling include confidential medical tests and discussions with a doctor or other health care provider to find, prevent and treat infections spread through sexual contact.

Part B also covers up to 2 face-to-face, high-intensity behavioral counseling sessions, each 20 to 30 minutes long. CMS describes this counseling as a program to promote sexual risk reduction or risk avoidance that includes education, skills training and guidance on how to change sexual behavior.

Who qualifies for Medicare STI screening?

You can get STI screenings if you're pregnant or at increased risk for an STI, and you can get the behavioral counseling sessions if you're a sexually active adult at increased risk for an STI. Your primary care provider decides whether you're at increased risk by asking about your sexual history, and CMS's coverage rule says community factors, like a high rate of STIs in the community, should also be considered. The rule lists these higher-risk sexual behaviors:

• Multiple sex partners
• Using barrier protection inconsistently
• Having sex under the influence of alcohol or drugs
• Having sex in exchange for money or drugs
• Age 24 or younger and sexually active, for women, for chlamydia and gonorrhea
• Having an STI within the past year
• IV drug use (for hepatitis B only)
• For men, men having sex with men and engaged in high-risk sexual behavior, regardless of age

How often does Medicare cover STI screening?

Medicare covers one STI screening every 12 months, or at certain times during pregnancy, and up to 2 behavioral counseling sessions a year. CMS's coverage rule sets the timing for each screening:

• Chlamydia and gonorrhea: pregnant women who are 24 or younger, or at increased risk, when the pregnancy is known, with a repeat screening in the third trimester if high-risk sexual behavior has occurred since the first test; and women at increased risk, once a year.
• Syphilis: pregnant women when the pregnancy is known, with repeat screening in the third trimester and at delivery if high-risk sexual behavior has occurred since the previous test; and men and women at increased risk, once a year.
• Hepatitis B: pregnant women at the first prenatal visit, with rescreening at delivery for those with new or continuing risk factors.

What do I pay for STI screening and counseling?

You pay nothing if your primary care doctor or other provider accepts assignment. CMS's coverage rule waives the Medicare coinsurance and the Part B deductible for these preventive services.

Where can I get Medicare-covered STI counseling?

Medicare only covers the counseling sessions with a provider in a primary care setting, like a doctor's office, and your health care provider must order the screening or refer you for counseling. Medicare won't cover the counseling as a preventive service in an inpatient setting, like a skilled nursing facility. CMS gives these examples of settings that don't count as primary care: emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, clinics that provide a limited focus of health care services, and hospice.

A counseling session can take place on the same day as a yearly "Wellness" visit or an evaluation and management visit, or during the billing period for pregnancy care, but Medicare covers only one counseling session on any one date of service.

Does Medicare cover HIV screening too?

Yes, Medicare Part B covers HIV screenings once a year if you're between 15 and 65, or if you're younger than 15 or older than 65 and at increased risk for HIV. If you're pregnant, you can get a screening up to 3 times during your pregnancy, and you pay nothing if your provider accepts assignment. See how Medicare covers HIV PrEP.