Georgia Medicare STI Screening HIBC 2026 Guide

The Medicare Sexually Transmitted Infections (STIs) Screening and High-Intensity Behavioral Counseling (HIBC) benefit is one of the most clinically important and most under-recognized preventive services for Medicare beneficiaries. The benefit reflects a public health reality that the Centers for Disease Control and Prevention have documented with increasing emphasis over the past decade: STI rates in the United States have risen substantially across all age groups, including among older adults, and the demographic patterns of STI transmission do not stop at age 65. For Georgia specifically, the public health context is acute. Georgia has consistently ranked among states with the highest reported STI rates nationally for chlamydia, gonorrhea, and syphilis. The metro Atlanta HIV/STI epidemiology has been a focus of CDC, state, and federal investment for decades, with concentrated transmission in specific demographic and geographic populations that intersect substantially with the Georgia Medicare beneficiary population.

By Brevy Care Team · Last verified May 14, 2026

The Medicare STIs Screening and HIBC benefit was established through CMS coverage decision under Section 1861(ddd) of the Social Security Act preventive services authority and codified as National Coverage Determination 210.10 effective November 8, 2011, the same day as NCD 210.11 (IBT for CVD). NCD 210.10 covers screening tests for four STIs — chlamydia, gonorrhea, syphilis, and hepatitis B — for sexually active adolescents and adults at increased risk for STIs, plus one annual 30-minute high-intensity behavioral counseling visit billed under HCPCS G0445. The four-STI screening list reflects the USPSTF Grade A and Grade B recommendation framework: syphilis screening in non-pregnant adults at increased risk (Grade A); chlamydia and gonorrhea screening in sexually active women age 24 and younger and older women at increased risk (Grade B; expanded clinical practice to include high-risk men); HBV screening in adults at high risk (Grade B). HIV screening is covered separately under NCD 210.7 (effective December 8, 2009), and the HIV pre-exposure prophylaxis (PrEP) coverage now falls under Section 1861(s)(10)(A) following the final NCD on HIV PrEP effective September 30, 2024.

The HIBC component of the benefit reflects the USPSTF Grade B recommendation for intensive behavioral counseling to prevent STIs in adolescents and adults at increased risk (2014, reaffirmed 2020). The HCPCS G0445 code authorizes one annual 30-minute face-to-face encounter with a qualified provider that addresses risk assessment, counseling about safer sex practices, partner discussions, harm reduction strategies, and where appropriate referral to additional services including HIV PrEP, addiction treatment, and partner notification.

For Georgia Medicare beneficiaries, the STIs Screening and HIBC benefit operates within a state landscape that includes substantial STI burden, a strong public health infrastructure anchored by the Georgia Department of Public Health STD/HIV Section, a robust Ryan White HIV/AIDS Program network providing comprehensive HIV care, the Grady Health System Infectious Disease Program (IDP) Ponce de Leon Center as one of the nation's largest comprehensive HIV care programs, the Emory Center for AIDS Research and Emory Infectious Disease programs, and federally qualified health centers across the state increasingly integrating STI screening into primary care workflows. The 2024 final NCD on HIV PrEP coverage under Section 1861(s)(10)(A) substantially expanded the Medicare framework for HIV prevention, transitioning PrEP from a beneficiary out-of-pocket expense (other than for those covered through Part D with associated cost-sharing) to a Part B-covered preventive service with $0 cost-sharing for the medication and associated services.

This guide explains how the Medicare STIs Screening and HIBC benefit works statutorily and clinically, what eligibility looks like for a Georgia Medicare beneficiary, what STI screening tests are covered and how they are coded, what the HIBC content entails, how the benefit coordinates with the Annual Wellness Visit and the Initial Preventive Physical Examination, how it coordinates with Medicare HIV screening under NCD 210.7 and the 2024 HIV PrEP coverage decision, how it coordinates with hepatitis B and hepatitis C screening, what cost-sharing applies under the ACA Section 4104 waiver, how STI treatment is covered under standard Part B and Part D rules, and what the Georgia STI surveillance and treatment landscape looks like for both primary care delivery of the benefit and for the specialty infectious disease and Ryan White-funded infrastructure that backs it up.

The Federal Framework Underlying the Medicare STIs Screening and HIBC Benefit

Section 1861(ddd) of the Social Security Act — Additional Preventive Services Authority

The statutory foundation is Section 1861(ddd) of the Social Security Act, codified at 42 U.S.C. 1395x(ddd), added by Section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, Public Law 110-275). The Section 1861(ddd) authority enabled CMS to add the STIs Screening and HIBC benefit through NCD 210.10 effective November 8, 2011.

NCD 210.10 — Screening for STIs and HIBC to Prevent STIs

NCD 210.10 covers:

• STI screening tests for chlamydia, gonorrhea, syphilis, and hepatitis B for sexually active adolescents and adults at increased risk for STIs.
• One annual 30-minute high-intensity behavioral counseling visit under HCPCS G0445 for adolescents and adults at increased risk.

The screening tests are covered when ordered by a qualified provider for a beneficiary meeting the high-risk criteria. The HIBC visit is covered once annually per beneficiary at increased risk, in a primary care setting, by a qualified primary care provider.

NCD 210.7 — Screening for HIV

NCD 210.7, effective December 8, 2009, covers:

• Annual HIV screening for beneficiaries at increased risk for HIV.
• One-time HIV screening for beneficiaries age 15-65 regardless of risk profile (consistent with USPSTF Grade A recommendation for universal HIV screening in this age range).
• HIV screening during pregnancy (not typically relevant to Medicare given age demographics but included for completeness).

HIV screening uses standard CPT codes (e.g., CPT 86701 antibody screening, CPT 86702 confirmatory testing). The USPSTF gives HIV screening Grade A for the universal recommendation, supporting ACA Section 4104 cost-sharing waiver applicability.

Final NCD on HIV PrEP — Section 1861(s)(10)(A) — Effective September 30, 2024

The Centers for Medicare and Medicaid Services finalized the National Coverage Determination on HIV Pre-Exposure Prophylaxis (PrEP) effective September 30, 2024, classifying HIV PrEP medications and associated services as Medicare Part B preventive services under Section 1861(s)(10)(A) of the Social Security Act. The transition from Part D coverage (with associated cost-sharing) to Part B preventive services coverage with $0 cost-sharing represented a substantial expansion of Medicare HIV prevention infrastructure.

The 2024 final NCD covers:

• PrEP medications including emtricitabine/tenofovir disoproxil fumarate (Truvada generic), emtricitabine/tenofovir alafenamide (Descovy), and cabotegravir long-acting injectable (Apretude).
• Associated services including HIV testing (initial and repeated), kidney function monitoring, STI screening, hepatitis B screening, and counseling.

Coverage is for beneficiaries at risk of HIV acquisition. The risk assessment is performed by the prescribing provider based on individual clinical evaluation rather than predefined demographic categories.

For Medicare beneficiaries, the practical effect of the 2024 PrEP coverage transition was substantial. Pre-2024, PrEP medications were covered under Part D, with associated cost-sharing (deductibles, copayments, coinsurance) that could be significant. Post-September 30, 2024, PrEP medications and associated services are covered under Part B preventive services with $0 cost-sharing, removing a substantial financial barrier to PrEP access for Medicare beneficiaries at risk of HIV acquisition.

42 CFR 410.64 — Additional Preventive Services Implementing Regulations

The Section 1861(ddd) authority is implemented through 42 CFR 410.64. For the STIs Screening and HIBC benefit, the regulation incorporates the NCD 210.10 framework.

USPSTF Recommendation Framework

The screening tests covered under NCD 210.10 align with USPSTF recommendations:

• Syphilis screening in non-pregnant adolescents and adults at increased risk: Grade A (2016 update, reaffirmed in subsequent reviews).
• Chlamydia and gonorrhea screening in sexually active women age 24 and younger and in older women at increased risk: Grade B (2014 update, reaffirmed 2021).
• Hepatitis B screening in adults at high risk: Grade B (2014 update, updated to universal Grade B in 2020).
• HIV screening in adolescents and adults age 15-65 (universal) and in older adults at increased risk: Grade A.

The HIBC component aligns with the USPSTF Grade B recommendation for intensive behavioral counseling to prevent STIs in adolescents and adults at increased risk (2014, reaffirmed 2020).

ACA Section 4104 Cost-Sharing Waiver

The ACA Section 4104 cost-sharing waiver applies to HCPCS G0445 (HIBC), the STI screening tests when ordered for screening rather than diagnostic purposes for symptomatic individuals, and HIV PrEP under the 2024 final NCD. The beneficiary owes nothing out of pocket for properly billed preventive services.

It is important to distinguish screening from diagnostic testing. Screening tests in asymptomatic high-risk beneficiaries are subject to the cost-sharing waiver. Diagnostic tests in symptomatic beneficiaries follow standard Part B cost-sharing rules.

Section 1861(ww) and Section 1861(hhh) Coordination

Both the IPPE (Section 1861(ww)) and the AWV (Section 1861(hhh)) include health risk assessment components that touch on sexual health, STI risk, and HIV risk. A positive risk identification during the IPPE or AWV may trigger the NCD 210.10 STI screening and HIBC pathway and/or the NCD 210.7 HIV screening pathway.

What Eligibility Looks Like for a Georgia Medicare Beneficiary

High-Risk Eligibility for STI Screening Under NCD 210.10

NCD 210.10 coverage of STI screening tests requires the beneficiary to be at increased risk for STIs. The risk assessment is performed by the qualified provider based on clinical evaluation. High-risk categories typically include:

• Multiple sex partners.
• New sex partners.
• Men who have sex with men (MSM).
• Exchange of sex for money or drugs.
• Injection drug use.
• History of prior STI.
• Sex while under the influence of substances.
• Partner with known STI, HIV, or hepatitis.
• Living in or traveling to areas of high STI prevalence.
• Other clinically identified increased-risk factors.

The high-risk eligibility framework is intentionally broad to accommodate the diversity of clinical situations. Documentation should reflect the specific risk factors identified.

HIBC Eligibility Under HCPCS G0445

The HIBC visit under HCPCS G0445 is available once annually for adolescents and adults at increased risk for STIs in a primary care setting by a qualified primary care provider. The 30-minute structure provides time for substantive risk assessment, education, and counseling. The annual frequency allows ongoing engagement across years rather than a single intervention.

HIV Screening Under NCD 210.7

HIV screening eligibility under NCD 210.7 includes:

• Universal one-time screening for all beneficiaries age 15-65 regardless of risk profile (consistent with 2013 USPSTF Grade A recommendation).
• Annual screening for beneficiaries at increased risk.
• Screening during pregnancy (not typically relevant for Medicare given age demographics).

For Medicare beneficiaries age 65 and older, the universal one-time HIV screening may technically have already been completed before Medicare enrollment (under non-Medicare coverage). For beneficiaries who did not receive HIV screening pre-Medicare or who have ongoing risk, NCD 210.7 supports continued or initial HIV screening.

HIV PrEP Eligibility Under 2024 Final NCD

HIV PrEP coverage under Section 1861(s)(10)(A) and the 2024 final NCD is for beneficiaries at risk of HIV acquisition. The prescribing provider determines individual eligibility based on clinical risk assessment. PrEP medications are appropriate for sexually active adults at risk of HIV acquisition through sexual contact, persons who inject drugs, and other risk situations.

The STI Screening Tests and Coding

Chlamydia Trachomatis Screening

Chlamydia is the most commonly reported STI in the United States. Screening uses nucleic acid amplification testing (NAAT) on urine, vaginal swab, urethral swab, or extragenital sites (oral, anal) depending on exposure pattern. CPT codes include:

• CPT 87491 — Chlamydia trachomatis amplified probe.
• CPT 87810 — Chlamydia trachomatis direct optical (rapid test) — less commonly used.

Neisseria Gonorrhoeae Screening

Gonorrhea is the second most commonly reported STI. Screening also uses NAAT, often as a combined panel with chlamydia testing. CPT codes include:

• CPT 87591 — Neisseria gonorrhoeae amplified probe.
• CPT 87850 — N. gonorrhoeae direct optical (rapid test) — less commonly used.

Combined chlamydia/gonorrhea NAAT panels are widely used in clinical practice.

Syphilis (Treponema Pallidum) Screening

Syphilis screening typically uses a two-test sequence:

• Non-treponemal antibody (RPR or VDRL): CPT 86592 (qualitative) or CPT 86593 (quantitative).
• Treponemal antibody: CPT 86780.

The traditional sequence is non-treponemal first, then treponemal confirmation. The "reverse algorithm" used in some settings reverses this order. Both algorithms are clinically acceptable.

Hepatitis B Surface Antigen Screening

HBV screening under NCD 210.10 uses HBsAg testing. NCD 210.10 HBV screening overlaps with the separate Medicare HBV screening framework (NCD-aligned coverage under Section 1861(ddd)) which expanded substantially through 2024 alignment with the 2020 USPSTF universal adult Grade B update. The three-test HBV panel (HBsAg, anti-HBs, anti-HBc) under HCPCS G0499 is the more comprehensive screening framework; NCD 210.10 HBV screening typically uses single-component HBsAg testing.

HIV Screening (Separately Under NCD 210.7)

HIV screening uses fourth-generation antigen/antibody combination assays (CPT 87389 or 86701/86702) followed by confirmatory testing per CDC HIV testing algorithm. Rapid HIV tests are also widely available in public health and community settings.

The HIBC Content Under HCPCS G0445

The high-intensity behavioral counseling visit is structured around a 30-minute encounter that allows substantive engagement with the beneficiary on STI prevention. Typical content includes:

Risk Assessment

• Sexual history including current partners, partner concurrency, partner risk factors.
• History of prior STIs.
• Condom use patterns.
• Substance use related to sexual activity.
• Sexual orientation and sexual practices.
• Other clinically relevant factors.

Education

• STI transmission mechanisms.
• STI symptoms and asymptomatic transmission.
• Importance of routine screening.
• Vaccine availability (HBV, HPV — although HPV vaccine is typically not Medicare-covered given age demographics).
• Available preventive interventions including HIV PrEP and post-exposure prophylaxis (PEP).

Behavior Change Counseling

• Condom use education.
• Partner discussion strategies.
• Negotiation skills for safer sex practices.
• Harm reduction approaches.
• Goal-setting for behavior change.

Referral and Coordination

• HIV PrEP referral where appropriate.
• Addiction treatment referral where appropriate.
• Partner notification services.
• Sexual health resources.
• Mental health support where appropriate.

The "high-intensity" framing of NCD 210.10 implies meaningful clinical engagement rather than brief generic counseling. The 30-minute duration provides time for substantive content.

Cost-Sharing Under ACA Section 4104

The ACA Section 4104 cost-sharing waiver applies to:

• The HCPCS G0445 HIBC visit when furnished in a primary care setting by a qualified primary care provider for a beneficiary at increased risk.
• The underlying STI screening tests when ordered for screening purposes (asymptomatic high-risk beneficiary).
• HIV PrEP medications and associated services under the 2024 final NCD.

Cost-sharing applies to:

• Diagnostic STI testing in symptomatic beneficiaries (standard Part B cost-sharing).
• STI treatment under standard Part B (for clinician-administered antibiotics) or Part D (for self-administered antibiotics).
• Downstream HIV treatment in beneficiaries diagnosed with HIV (covered under Part D with standard cost-sharing, with substantial cost-sharing reduction under the IRA $2,000 Part D out-of-pocket cap effective 2025).

Coordination With HIV Screening and PrEP

HIV Screening Coordination Under NCD 210.7

NCD 210.7 HIV screening operates alongside NCD 210.10 STI screening. Typical clinical practice combines HIV testing with chlamydia/gonorrhea/syphilis testing as a comprehensive STI screening panel, with the underlying tests billed under their respective CPT codes and the HIBC visit billed under G0445 if the beneficiary meets the high-risk criteria.

HIV PrEP Coordination Under 2024 Final NCD

The 2024 final NCD on HIV PrEP under Section 1861(s)(10)(A) substantially expanded the Medicare HIV prevention infrastructure:

• Pre-September 30, 2024: PrEP medications were covered under Part D with associated cost-sharing.
• Post-September 30, 2024: PrEP medications and associated services are covered under Part B preventive services with $0 cost-sharing.

The transition removed a substantial financial barrier to PrEP access for Medicare beneficiaries. For beneficiaries identified during the HIBC visit as candidates for PrEP, referral to a PrEP-prescribing provider is a natural component of the counseling content.

Coordination With HBV and HCV Screening

HBV screening overlaps with the separate Medicare HBV screening framework (HCPCS G0499 three-test panel covering HBsAg, anti-HBs, anti-HBc; effective 2016 high-risk, expanded 2024 universal). HCV screening operates under NCD 210.13 (effective June 2, 2014, with March 2020 reconsideration aligning with 2020 USPSTF universal adult Grade B; HCPCS G0472).

For Medicare beneficiaries undergoing comprehensive STI screening, the typical panel may include:

• Chlamydia (CPT 87491).
• Gonorrhea (CPT 87591).
• Syphilis (CPT 86592, 86593, 86780).
• HIV (CPT 87389 or 86701/86702).
• HBV (HCPCS G0499 or NCD 210.10 HBsAg).
• HCV (HCPCS G0472).

All preventive screening tests are covered with $0 cost-sharing under ACA Section 4104 alignment, assuming the beneficiary meets each test's specific eligibility criteria.

STI Treatment Framework Under Medicare

STI treatment is not a preventive service and is covered under standard Medicare cost-sharing rules:

• Chlamydia treatment: Doxycycline (Part D) or azithromycin (Part D). Standard antibiotic regimens are short-course.
• Gonorrhea treatment: Ceftriaxone intramuscular injection (Part B when clinic-administered) or other regimens. Treatment guidelines updated 2020 emphasizing ceftriaxone monotherapy at 500 mg.
• Syphilis treatment: Penicillin G benzathine intramuscular injection (Part B when clinic-administered). Treatment varies by stage (primary/secondary, latent, tertiary, neurosyphilis).
• HBV treatment: For chronic HBV, tenofovir or entecavir under Part D with standard cost-sharing.
• HIV treatment: Antiretroviral therapy under Part D with standard cost-sharing, with substantial cost-sharing reduction under the IRA $2,000 Part D out-of-pocket cap effective 2025.

For Georgia beneficiaries, STI treatment is widely available through primary care, infectious disease specialty practices, FQHCs, and Georgia DPH STD/HIV clinics. The Georgia DPH STD/HIV Section provides free or sliding-scale STI treatment regardless of insurance status in many counties.

The Georgia STI Surveillance and Treatment Landscape

STI Disease Burden in Georgia

Georgia has consistently ranked among states with the highest reported STI rates nationally. CDC surveillance data show Georgia in the top tier for chlamydia rates, gonorrhea rates, and syphilis rates. The disease burden is geographically concentrated in metro Atlanta and certain rural counties, and demographically concentrated in specific populations including African American communities and MSM populations.

Georgia DPH STD/HIV Section

The Georgia Department of Public Health STD/HIV Section operates state-level STI and HIV surveillance, partner notification services, and a network of state and county STD/HIV clinics providing free or sliding-scale STI screening and treatment regardless of insurance status. The STD/HIV Section coordinates with the CDC Division of STD Prevention and the CDC Division of HIV Prevention.

Ryan White HIV/AIDS Program in Georgia

The Ryan White HIV/AIDS Program, administered through HRSA, provides comprehensive HIV care services to people living with HIV who lack adequate insurance or financial resources. In Georgia, Ryan White Parts A, B, C, and D fund a network of providers including the Grady Health System IDP Ponce de Leon Center, the Emory Center for AIDS Research-affiliated programs, AID Atlanta, and a network of county and community-based programs across the state.

For Medicare beneficiaries with HIV, Medicare is the primary payer for HIV care, with Ryan White providing wraparound services (medication assistance, transportation, case management, mental health support) that Medicare does not fully cover.

Grady Health System IDP Ponce de Leon Center

The Grady IDP Ponce de Leon Center in Atlanta is one of the largest comprehensive HIV care programs in the United States, serving thousands of patients across HIV primary care, specialty consultation, mental health, social services, and research. The center is closely affiliated with Emory University School of Medicine and is a major Ryan White Part C-funded program.

Emory Infectious Disease and Emory Center for AIDS Research

The Emory Center for AIDS Research (CFAR) and Emory Infectious Disease division provide academic infectious disease consultation, HIV primary care, STI prevention services, and clinical research across multiple metro Atlanta sites including Emory University Hospital, Emory University Hospital Midtown, and affiliated sites.

Federally Qualified Health Centers and FQHC Look-Alikes

Georgia's FQHC network increasingly integrates STI screening, HIV testing, HIV PrEP, and HIV care into primary care delivery. FQHCs are particularly important for rural Georgia counties where specialty infectious disease access is limited.

Community-Based Organizations

AID Atlanta, the Atlanta Harm Reduction Coalition, and other community-based organizations provide STI prevention, HIV testing, PrEP navigation, and harm reduction services across metro Atlanta.

Best Practices for Georgia Medicare Beneficiaries

1. Have an honest conversation with your primary care provider about sexual health at your annual visit. The high-risk eligibility framework under NCD 210.10 depends on accurate information about your sexual history, partners, and risk factors.

2. Confirm STI screening and HIBC are billed correctly for $0 cost-sharing. STI screening tests should be billed as screening (not diagnostic) when you are asymptomatic, and HIBC should be billed under HCPCS G0445.

3. Schedule the annual HIBC visit alongside or shortly after your Annual Wellness Visit. The AWV health risk assessment provides natural context for sexual health conversation, and HIBC can build on that context.

4. Ask about HIV PrEP if you have ongoing HIV risk. The 2024 final NCD on HIV PrEP under Section 1861(s)(10)(A) made PrEP medications and associated services Part B preventive services with $0 cost-sharing effective September 30, 2024.

5. Use the comprehensive STI screening panel when appropriate. A combined panel for chlamydia, gonorrhea, syphilis, HIV, and HBV (and HCV under NCD 210.13) provides comprehensive infectious disease screening across the major USPSTF-recommended tests.

6. Use extragenital testing where exposure pattern indicates. Oral and anal exposure sites can be screened with chlamydia/gonorrhea NAAT in addition to genital sites. Discuss exposure pattern openly with your provider.

7. Use Georgia DPH STD/HIV clinics for additional STI services where local primary care is constrained. The DPH clinics provide free or sliding-scale STI screening and treatment regardless of insurance status.

8. Use Ryan White-funded programs if you are diagnosed with HIV. Ryan White wraparound services complement Medicare HIV coverage and provide medication assistance, transportation, case management, and other supports.

9. Use the Grady IDP Ponce de Leon Center or Emory Infectious Disease for complex HIV care. Both programs are among the most comprehensive in the country.

10. Use CDC-INFO (1-800-232-4636) for STI prevention and testing information. The CDC also maintains a GetTested.cdc.gov tool for locating local testing sites.

11. Use PrEP medications under the 2024 NCD with $0 cost-sharing. Truvada (generic emtricitabine/tenofovir disoproxil fumarate), Descovy (emtricitabine/tenofovir alafenamide), and Apretude (cabotegravir long-acting injectable) are covered under Part B with $0 cost-sharing.

12. Discuss condom use openly with your provider. Condoms remain the single most effective STI prevention method short of abstinence.

13. Use partner notification services through Georgia DPH if you are diagnosed with an STI. Partner notification protects partners and limits onward transmission.

14. Use GeorgiaCares SHIP (1-866-552-4464) or the Medicare Rights Center (1-800-333-4114) for Medicare coverage questions related to STI screening, HIBC, HIV PrEP, or HIV treatment.

Common Issues Georgia Medicare Beneficiaries Encounter

1. STI screening is billed as diagnostic rather than screening, triggering cost-sharing. Verify that asymptomatic screening tests are billed appropriately under preventive service codes. Cost-sharing applies to diagnostic testing in symptomatic beneficiaries but not to screening in asymptomatic high-risk beneficiaries.

2. The HIBC visit is performed but not separately billed under G0445. If the three components of the HIBC (risk assessment, education, behavior change counseling) are addressed during a primary care visit but the visit is billed under E/M codes only, the beneficiary does not receive the documented preventive service or the cost-sharing waiver.

3. Primary care providers unfamiliar with NCD 210.10 do not offer HIBC despite beneficiary risk profile. Many primary care providers have not implemented HIBC workflows. Beneficiaries can advocate for the benefit, request referral to a provider who does offer it, or access through FQHCs.

4. The high-risk eligibility framework is interpreted narrowly. NCD 210.10 high-risk eligibility is intentionally broad. Beneficiaries who report any of the high-risk factors are typically eligible. Provider documentation should reflect the specific risk factors identified.

5. HIV PrEP coverage transitions are not fully implemented. Although the 2024 final NCD is effective September 30, 2024, full operational implementation across providers, MA plans, and pharmacy benefit managers may take time. Beneficiaries should verify Part B PrEP coverage with their provider and plan.

6. STI treatment cost-sharing surprises beneficiaries. Although screening is $0, treatment follows standard cost-sharing rules. Beneficiaries with newly diagnosed STIs may face Part D cost-sharing for oral antibiotics.

7. Specialty infectious disease access is limited in rural Georgia counties. If specialty consultation is needed and local access is limited, telehealth-based infectious disease consultation, FQHC-based services, and Ryan White-funded programs may provide alternatives.

8. Older adults are under-screened for STIs. STI rates among adults age 65 and older have risen substantially over the past decade, but clinical practice has historically under-recognized STI risk in older adults. Beneficiaries can advocate for screening when they identify ongoing risk.

9. Telehealth coverage of HIBC is unclear. Medicare's telehealth coverage of behavioral counseling has expanded substantially. Current telehealth coverage rules for G0445 should be confirmed with your provider's billing office.

10. Partner notification raises confidentiality concerns. Georgia DPH partner notification services use trained disease intervention specialists who maintain confidentiality. Beneficiaries can choose between provider-assisted, third-party (DPH), or self-notification.

11. HIV PrEP requires regular monitoring. PrEP regimens require HIV testing (initial and approximately quarterly), kidney function monitoring, and STI screening per CDC PrEP guidelines. The 2024 final NCD covers these monitoring services.

12. Coordination with Ryan White case management. Ryan White case managers can help navigate insurance coverage, medication access, and ancillary services for beneficiaries with HIV.

13. Dual-eligible beneficiaries may have additional Medicaid coverage. Georgia Medicaid covers some STI prevention and treatment services that complement Medicare coverage.

14. Medicare Advantage plans may have additional STI prevention benefits. Some MA plans offer supplemental benefits beyond standard Part B coverage.

Worked Examples for Georgia Medicare Beneficiaries

Example 1: Fulton County 67-Year-Old Newly Sexually Active After Spouse Death STI Screening + HIBC

A 67-year-old woman in Fulton County, recently widowed and reporting being newly sexually active with a new partner, presents to her Emory Primary Care internist for an annual visit. During the AWV health risk assessment, the beneficiary discusses her new relationship and her uncertainty about her partner's STI status. The internist documents the increased-risk profile and offers comprehensive STI screening and HIBC. The 30-minute G0445 HIBC visit addresses risk assessment, condom use education, partner discussion strategies, and STI screening recommendations. The internist orders chlamydia (CPT 87491), gonorrhea (CPT 87591), syphilis (CPT 86592), HIV (CPT 87389), and HBV (HCPCS G0499 three-test panel) screening, plus HCV (HCPCS G0472) under the universal Grade B alignment. All tests return negative. G0445 and all screening tests are billed at $0 cost-sharing under ACA Section 4104.

Example 2: DeKalb County 70-Year-Old MSM At-Risk Annual STI Screening + HIBC + PrEP Referral

A 70-year-old man in DeKalb County, identifying as MSM with multiple recent partners, presents to his Piedmont primary care provider. The provider documents the high-risk profile and initiates comprehensive STI screening (chlamydia, gonorrhea, syphilis, HIV, HBV) plus G0445 HIBC. The HIBC addresses risk assessment, HIV PrEP discussion under the 2024 final NCD, condom use education, and referral to the Grady IDP Ponce de Leon Center for PrEP prescribing and ongoing management. Following the 2024 NCD, the beneficiary initiates Descovy under Part B preventive services coverage with $0 cost-sharing. Quarterly HIV testing, kidney function monitoring, and STI rescreening are scheduled per CDC PrEP guidelines, all covered under Part B preventive services.

Example 3: Cobb County 65-Year-Old Newly Medicare-Eligible HIBC Entry to Prevention

A 65-year-old man in Cobb County newly enrolled in Medicare Part B, with prior history of multiple sex partners and inconsistent condom use, presents to his Wellstar primary care provider for IPPE. The IPPE health risk assessment identifies STI risk. The provider initiates G0445 HIBC during a follow-up visit, addressing risk assessment, education, behavior change counseling, and STI screening. Comprehensive STI screening returns one positive result: syphilis non-treponemal RPR positive with confirmatory treponemal antibody positive, consistent with treated past syphilis based on historical clinical pattern. The provider coordinates with infectious disease consultation for staging and treatment determination. G0445 and screening tests billed at $0 cost-sharing.

Example 4: Crisp County 72-Year-Old Syphilis Screening With Positive Result Linked to Treatment

A 72-year-old man in Crisp County (rural southwest Georgia) presents to his FQHC primary care provider for an annual visit. The provider documents high-risk profile based on sexual history and orders STI screening including syphilis (CPT 86592 RPR + CPT 86780 treponemal antibody). RPR returns positive at 1:16 titer; treponemal antibody positive. The clinical pattern is consistent with active syphilis. The provider coordinates with the Georgia DPH STD/HIV Section for confirmatory testing, staging determination, and partner notification. The beneficiary receives penicillin G benzathine 2.4 million units intramuscular injection at the FQHC under standard Part B cost-sharing. RPR follow-up at 3, 6, and 12 months documents serologic response. G0445 HIBC visit is integrated with the treatment workflow at $0 cost-sharing.

Example 5: Bibb County 68-Year-Old Chlamydia/Gonorrhea Screening NAAT Workflow

A 68-year-old woman in Bibb County, with reported new sex partner in the past year, presents to her Atrium Health Navicent primary care provider. The provider documents the increased-risk profile and orders chlamydia/gonorrhea combined NAAT (CPT 87491 + 87591) using a vaginal swab, plus syphilis screening and HIV screening. Chlamydia NAAT returns positive. The provider initiates doxycycline 100 mg twice daily for 7 days under Part D coverage with standard cost-sharing. Partner notification is initiated through Georgia DPH disease intervention specialists. Test-of-cure rescreening is scheduled at 3 months. G0445 HIBC visit reinforces safer sex practices, condom use, and partner notification. Screening tests billed at $0 cost-sharing; treatment under standard Part D rules.

Example 6: Hall County 65-Year-Old HBV/HCV/HIV/Syphilis Comprehensive Screening Panel

A 65-year-old man in Hall County, newly Medicare-eligible with past history of injection drug use (now in recovery for 10 years) and remote tattoo exposure, presents to his Northeast Georgia Medical Center primary care provider for IPPE. The provider documents high-risk profile based on past IDU and offers comprehensive infectious disease screening: HBV three-test panel (HCPCS G0499), HCV antibody (HCPCS G0472), HIV (CPT 87389), syphilis (CPT 86592 + 86780), chlamydia/gonorrhea (CPT 87491 + 87591). Results: HBsAg negative, anti-HBs positive, anti-HBc positive (past resolved HBV with immunity); HCV antibody positive (confirmed by HCV RNA quantitative). The beneficiary is linked to Emory Hepatology for HCV DAA treatment under Part D (Mavyret 8 weeks, achieving SVR-12 cure). G0499 + G0472 + HIV + syphilis + chlamydia/gonorrhea screening + G0445 HIBC all billed at $0 cost-sharing.

Contacts and Resources

This guide reflects Medicare STIs Screening and HIBC coverage as of 2026-05-14 and applies to Georgia Medicare beneficiaries.

Find personalized help navigating Medicare STI screening and HIBC coverage at brevy.com.