National Coverage Analysis (NCA) Tracking Sheet

Screening for the Human Immunodeficiency Virus (HIV) Infection



Over the past 25 years, the Congress has added coverage of specific preventive and screening services to the Medicare Part B program such as Pap smear and screening pelvic exams, screening mammograms, colorectal cancer screening tests and diabetes screening tests. Effective January 1, 2009, CMS is allowed to add coverage of "additional preventive services" if certain statutory requirements are met, as provided under section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Public Law 110-275). Specifically, this new benefit allows CMS under 42 CFR 410.64 to cover "additional preventive services" not otherwise described in Title XVIII of the Act, if it determines through the national coverage determination (NCD) process that the service is recommended with a grade A (strongly recommends) or grade B (recommends) rating by the United States Preventive Services Task Force (USPSTF) and meets certain other requirements.

After reviewing various preventive services which the USPSTF has given a grade A or grade B rating in recent years, CMS has decided to initiate a national coverage analysis (NCA) on screening for Human Immunodeficiency Virus (HIV) infection, which has been strongly recommended by the USPSTF for all adolescents and adults at increased risk for HIV infection and all pregnant women.

This NCA will evaluate the available evidence for screening for HIV infection and determine if a national coverage determination is warranted.

Benefit Category

Additional Preventive Services

Requestor Information

Requestor NameRequestor Letter
Internally generated N/A

Important Dates

Formal Request Accepted and Review Initiated
Expected NCA Completion Date
Public Comment Period
03/13/2009 - 04/12/2009
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
09/09/2009 - 10/09/2009
Decision Memo Released
Comments for this NCA
View Public Comments


Lead Analysts
William Larson, MA
Lead Medical Officers
Lawrence Schott, MD, MS

Actions Taken

March 13, 2009

CMS initiates this national coverage analysis for the Human Immunodeficiency Virus (HIV) infection screening. The public has 30 days to submit comments on this topic. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information related to the screening tests under review. We are especially interested as to the types of studies needed if the evidence is determined to be premature for coverage or if the appropriate frequency interval is uncertain.

September 9, 2009

CMS is posting the proposed decision memorandum which begins a 30-day public comment period.

December 8, 2009