Georgia Medicare Hepatitis B Screening Vaccine 2026 Guide

Georgia Medicare hepatitis B screening costs you nothing if you are pregnant or at high risk, and a provider orders it. Medicare Part B covers the hepatitis B (HBV) three-test panel at $0 when your provider accepts assignment. The hepatitis B vaccine is also $0 under Part B on any of three conditions: no complete vaccine series, unknown vaccination history, or medium-to-high risk such as diabetes. This guide explains who qualifies, what the tests and vaccine cost, and where to get care in Georgia.

Hepatitis B matters especially in Georgia. Chronic HBV infection is far more common in the Asian American and African immigrant communities concentrated in metro Atlanta, where many people acquired the virus at birth and have carried it silently for decades. Screening finds those infections so they can be treated, and vaccination prevents new ones. The catch that trips up many beneficiaries: the screening blood test and the vaccine follow two different Medicare coverage rules, and neither is automatically free for everyone. This guide walks through both.

Georgia Medicare Hepatitis B Screening: What Part B Covers

Medicare Part B covers hepatitis B screening at $0 to the beneficiary, with no deductible and no coinsurance when the provider accepts assignment, for people who are pregnant or at high risk for HBV infection. The coverage flows from the additional-preventive-services authority in Social Security Act Section 1861(ddd), the same authority under which the United States Preventive Services Task Force (USPSTF) Grade B recommendation lets Medicare add screening benefits. The instrument that carries the benefit is National Coverage Determination 210.6, effective September 28, 2016, and it sets two requirements: a provider has to order the screening, and you have to meet one of the two qualifying conditions, high risk for HBV infection or pregnancy.1,2

Hepatitis B screening sits inside Medicare's broader set of preventive and screening services that Part B covers at no cost when the provider accepts assignment.6 Because the risk categories are broad and many people never knew they were exposed, clinicians often screen widely. A beneficiary who does not fall into a covered category can still be tested, but that visit may carry standard Part B cost-sharing.

Who Qualifies for Georgia Medicare Hepatitis B Screening

Two groups get hepatitis B screening at no cost: beneficiaries who are pregnant, and beneficiaries at high risk for HBV infection. Either way, a provider has to order it. CMS's implementing guidance defines high risk as:1,2

• People born in countries or regions where hepatitis B prevalence is 2 percent or higher.
• U.S.-born people not vaccinated as infants whose parents were born in regions where prevalence is 8 percent or higher.
• People with HIV infection.
• Men who have sex with men.
• People who inject drugs.
• Household contacts or sexual partners of people with hepatitis B infection.

That first category is the one that matters most in Georgia. Hepatitis B is common across much of East Asia, Southeast Asia, the Pacific Islands, and sub-Saharan Africa, so for many beneficiaries born there, country of birth alone is what puts them in the covered group.

The USPSTF's broader at-risk list, which many clinicians work from, also takes in people with multiple sexual partners or a history of a sexually transmitted infection, healthcare and public-safety workers with blood or body-fluid exposure, and people on long-term hemodialysis. Those groups sit outside the categories CMS's guidance names, so ask the provider how the test will be billed before assuming it comes at no cost.

Beneficiaries with ongoing risk, such as continued injection drug use or a household contact who is infected, can be rescreened over time. Because country of birth is itself a covered risk factor, screening Georgia beneficiaries from high-prevalence communities is both covered and especially worthwhile.

The HCPCS G0499 Three-Test Panel

Medicare covers hepatitis B screening as a preventive benefit for pregnant and high-risk beneficiaries, and bills it under HCPCS code G0499.1,2 The screening runs as a three-test panel:

• HBsAg (hepatitis B surface antigen): a positive result signals current infection.
• Anti-HBs (antibody to surface antigen): a positive result signals immunity, from either vaccination or a resolved past infection.
• Anti-HBc (antibody to core antigen): a positive result signals past or present infection; it does not come from the vaccine.

Read together, the three tests separate the main possibilities:

• Susceptible (never infected, never vaccinated): all three negative. A candidate for vaccination.
• Vaccine-induced immunity: HBsAg negative, anti-HBs positive, anti-HBc negative.
• Past resolved infection with immunity: HBsAg negative, anti-HBs positive, anti-HBc positive.
• Chronic infection: HBsAg positive (persisting longer than six months), anti-HBc positive. This result needs linkage to hepatology care.
• Isolated anti-HBc: only anti-HBc positive. An ambiguous pattern that may need follow-up testing, including an HBV DNA test.

When screening finds chronic infection, follow-up tests (HBV DNA viral load, liver enzymes, a fibrosis assessment such as FibroScan, and hepatocellular carcinoma surveillance imaging) guide treatment. Those diagnostic tests are covered under standard Part B cost-sharing, not the no-cost screening waiver.

What Hepatitis B Screening and Vaccination Cost

Screening: $0. Hepatitis B screening (G0499) costs the beneficiary nothing when a provider orders it for a pregnant or high-risk beneficiary and the provider accepts assignment. The Part B deductible and coinsurance are waived.1,2

Vaccine: $0 on any one of three conditions. Medicare Part B covers the hepatitis B vaccine and its administration at $0 if you meet at least one of three conditions: you never got a complete hepatitis B series, you do not know your vaccination history, or you have a health condition or situation that puts you at medium or high risk (diabetes, end-stage renal disease, or living with someone who has hepatitis B). Medium or high risk is one route in, not a requirement. A beneficiary who meets none of the three would face standard Part B cost-sharing.3

The Inflation Reduction Act made all Advisory Committee on Immunization Practices (ACIP)-recommended vaccines under Part D free (no deductible, no copay) as of January 1, 2023, which is why the shingles, RSV, and Tdap vaccines now cost nothing. But the hepatitis B vaccine is a Part B vaccine, not a Part D one, so it keeps the Part B three-condition rule rather than being free for everyone.3

Antiviral treatment: through Part D. If screening finds chronic hepatitis B that needs treatment, the antiviral drugs (tenofovir alafenamide, tenofovir disoproxil fumarate, or entecavir) are covered under Medicare Part D, usually with prior authorization. Because treatment is long-term, the Inflation Reduction Act's Part D out-of-pocket cap matters: annual out-of-pocket spending on covered drugs is capped at $2,000 in 2025 and $2,100 in 2026, after which you pay $0 for the rest of the year.4

Downstream care: Confirmatory testing, hepatology visits, and cancer-surveillance imaging carry standard Part B cost-sharing. A Medigap policy, or Medicaid for a dually eligible beneficiary, can reduce or eliminate those amounts.

The Hepatitis B Vaccine Under Medicare Part B

Medicare has covered the hepatitis B vaccine under Part B for people at intermediate or high risk since the 1980s. Today the vaccine is $0 for a beneficiary who meets any one of Medicare's three conditions and whose provider accepts assignment, and carries standard cost-sharing otherwise.3

For a susceptible beneficiary who qualifies, the vaccine is given as a series: a three-dose schedule (Engerix-B, Recombivax HB, or PreHevbrio) or a two-dose schedule (Heplisav-B). Post-vaccination antibody testing is not routine for healthy adults, though it is sometimes done for people with high exposure risk. Beneficiaries who think they were vaccinated years ago but lack records can have an anti-HBs test to check whether they are still immune.

Hepatitis B in Georgia's Communities

Hepatitis B is unevenly distributed. In the United States it is uncommon in the general population but substantially more common in people born in East Asia, Southeast Asia, the Pacific Islands, and sub-Saharan Africa, where most infections are passed from mother to child at birth. Asian Americans and African immigrants together account for a large share of chronic hepatitis B in the country, and many of those infections have been silent for decades. Left untreated, chronic hepatitis B is a leading cause of cirrhosis and liver cancer, which is exactly why finding it early changes outcomes.

Georgia carries meaningful concentrations of higher-risk populations:

• Metro Atlanta has the Southeast's largest Asian American population, with substantial Korean, Vietnamese, Chinese, Indian, and Filipino communities, notably along the Buford Highway corridor in DeKalb and Gwinnett counties.
• African immigrant communities from Ethiopia, Nigeria, Somalia, Sudan, and the Democratic Republic of Congo are substantial across metro Atlanta.
• Refugees from high-prevalence countries have been resettled in Georgia, particularly around Clarkston in DeKalb County.

For beneficiaries from these communities, country of birth alone is a covered screening risk factor, so screening is both covered and high-value. Family-based screening matters too: when screening finds chronic hepatitis B in one person, household members and sexual partners should be screened and, if susceptible, vaccinated.

Getting Care in Georgia

Hepatitis B screening is available at any primary care practice or Medicare-enrolled lab, and the vaccine at any Medicare-enrolled provider, including pharmacies and community health centers. For chronic hepatitis B that needs specialty management, major Georgia hepatology programs at Emory, Wellstar, Piedmont, Northside, and Augusta University provide antiviral treatment, liver-cancer surveillance, and transplant evaluation. Federally Qualified Health Centers across Georgia offer screening and integrated care for immigrant and medically underserved communities, often with multilingual staff.

Community health organizations, including the Center for Pan Asian Community Services (CPACS) and refugee-focused agencies in the Clarkston area, support culturally and linguistically appropriate hepatitis B education and screening. Beneficiaries with HIV and hepatitis B coinfection can coordinate care through Ryan White HIV/AIDS Program-funded clinics in metro Atlanta.

Worked Examples

These scenarios are illustrative composites, not real individuals, and are meant to show how the coverage rules play out.

A Vietnamese American man whose screening finds chronic hepatitis B

A 68-year-old man in Fulton County, on Original Medicare, immigrated from Vietnam decades ago and has never been screened. His primary care provider, recognizing country of birth as a covered risk factor, orders the G0499 panel at $0.1,2 The result (HBsAg positive, anti-HBc positive) shows chronic infection. He is referred to Emory Hepatology, started on a Part D antiviral with prior authorization, and set up for twice-yearly liver-cancer surveillance. His wife and adult children are screened; his susceptible daughter is offered vaccination. The screening cost him nothing; his Medigap plan and the Part D out-of-pocket cap hold down the downstream costs.4

An Ethiopian immigrant with a resolved past infection

A 70-year-old woman in Clarkston, dually eligible for Medicare and Georgia Medicaid, was born in Ethiopia and has never been screened. Because country of birth is a covered risk factor, her FQHC orders the G0499 panel at $0.1,2 The result (only anti-HBc positive) is ambiguous, so a follow-up HBV DNA test is done; it is negative, consistent with a past infection that resolved on its own. She needs no antiviral treatment. Her Medicaid coverage picks up the diagnostic HBV DNA test's Part B cost-sharing.

A beneficiary with diabetes who qualifies for the $0 vaccine

A 67-year-old woman in Cobb County has type 2 diabetes and is not immune to hepatitis B. Because diabetes puts her at medium-to-high risk, Medicare Part B covers her hepatitis B vaccine at $0 when her provider accepts assignment.3 She completes the two-dose Heplisav-B series. A neighbor the same age with no risk conditions asks about the vaccine and learns she qualifies anyway: she never completed a hepatitis B series, which is one of Medicare's three conditions on its own.

HIV and hepatitis B coinfection

A 72-year-old man in DeKalb County on Original Medicare has long-standing chronic hepatitis B and HIV, managed jointly by Emory hepatology and infectious disease. His antiretroviral regimen contains tenofovir, which suppresses both viruses at once, so his Part D coverage of HIV therapy also covers his hepatitis B antiviral needs. He gets twice-yearly liver-cancer surveillance and stays virally suppressed on both fronts.

Resources and Contacts

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