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Does Medicare cover a hepatitis B test?

Yes, as a screening, if you fit one of two groups: people Medicare defines as at high risk for hepatitis B, and people who are pregnant. The test is $0 when the provider accepts assignment, and it has to be ordered by a primary care provider in a primary care setting. If you have already had the hepatitis B vaccine and are not pregnant, the screening is not covered.

This page is about the screening test for people without symptoms. For how often Medicare pays for blood work and other screening tests, see our free chart of Medicare's screening schedules.

Who counts as high risk

Medicare.gov says only "You're at high risk for HBV infection." The national coverage rule, NCD 210.6, says what that means: "'High risk' is defined as persons born in countries and regions with a high prevalence of HBV infection (i.e., ≥ 2%), US born persons not vaccinated as infants whose parents were born in regions with a very high prevalence of HBV infection (i.e., ≥ 8%), HIV-positive persons, men who have sex with men, injection drug users, household contacts or sexual partners of persons with HBV infection."

The "≥" sign means "at or above." So the first group is people born where 2 percent or more of the population has hepatitis B, and the second is people born in the United States, not vaccinated as babies, whose parents were born where 8 percent or more of the population has it.

Medicare's provider chart describes the people covered as "High-risk, asymptomatic non-pregnant adolescents and adults" and "Pregnant women." Asymptomatic means without symptoms.

How often Medicare pays

The provider chart gives three schedules:

• One screening "for non-pregnant adolescents and adults who meet the high-risk definition."
• Once a year "for patients with continued high risk who don't get HBV" vaccination. The rule narrows what continued high risk means: "CMS has determined that repeated screening would be appropriate annually only for beneficiaries with continued high risk (i.e., men who have sex with men, injection drug users, household contacts or sexual partners of persons with HBV infection) who do not receive hepatitis B vaccination." That is a shorter list than the high-risk definition above. Being born in a high-prevalence country, for example, qualifies you for one screening but is not on the yearly list.
• In pregnancy, "One screening for pregnant women at first prenatal visit, and rescreening at delivery for those with new or continued risk factors."

Medicare.gov describes only the yearly and pregnancy schedules: "Once a year if you're at continued high risk and don't get a hepatitis B vaccine," the "First prenatal visit," and the "Time of delivery if you have new or continued risk factors." It does not mention the one-time screening for everyone else on the high-risk list. The rule and the provider chart, quoted above, do.

Who has to order it

The rule requires that the test be ordered by a primary care physician or practitioner "within the context of a primary care setting." A screening ordered somewhere else is outside the rule.

When it is not covered

The rule says the screening is not covered for people who are "nonpregnant and have already received a hepatitis B vaccination." If you were vaccinated and are not pregnant, the screening test is outside the rule.

What you pay

Medicare.gov: "You pay nothing if your health care provider accepts assignment." The provider chart: "No copayment, coinsurance, or deductible."

The codes on the claim

In one line: for a non-pregnant person at high risk, the code is G0499, which the provider chart describes as "Hepatitis B screening in non-pregnant, high risk individual" and which bundles three tests, the hepatitis B surface antigen (HBsAg), antibodies to it (anti-HBs), and antibodies to the hepatitis B core antigen (anti-HBc), plus a confirming test "only for an initially reactive HBsAg result." For a pregnant patient the chart lists separate CPT codes: 86704, 86706, 87340, and 87341.

The diagnosis codes, in one line: for a high-risk non-pregnant person the chart pairs Z11.59 with Z72.89; for a pregnant patient it pairs Z11.59 with one of the pregnancy codes Z34.00 through Z34.93.

What the Preventive Services Task Force says

The U.S. Preventive Services Task Force's December 15, 2020 recommendation on screening for hepatitis B virus infection is Grade B, and its risk groups match Medicare's list. We found no change to Medicare's rule or the Task Force recommendation in 2025 or 2026.

If you have symptoms, or want the hepatitis C test

Everything above is about screening, which the provider chart limits to people who are "asymptomatic." If you have symptoms, the test your doctor orders is a diagnostic test, not this screening; see our page on the acute hepatitis panel. Hepatitis C screening has its own Medicare rule; see our page on hepatitis C screening.

If you have Medicare Advantage

A plan can have its own rules about which lab you use and whether the order needs approval first. For what can and cannot change under a plan, see Medicare Advantage and lab tests.

Before you go

This is ClaraCover's checklist, built from the rules above.

1. Do you fit Medicare's high-risk definition, or are you pregnant? The definition is quoted above. It is Medicare's list, not a judgment about you, and your doctor's office can tell you whether your situation is on it.
2. Have you had the hepatitis B vaccine? If you have, and you are not pregnant, the screening is not covered.
3. Is a primary care provider ordering it? The rule requires a primary care physician or practitioner in a primary care setting.
4. Have you had this screening before? One screening is covered for anyone on the high-risk list. A repeat is covered yearly only for the shorter continued-risk list, and only without the vaccine.

Sources

• Medicare.gov: Hepatitis B Virus (HBV) infection screenings
• CMS: National Coverage Determination 210.6, Screening for Hepatitis B Virus (HBV) Infection (effective September 28, 2016)
• CMS: Medicare Preventive Services educational tool (MLN006559, July 2026), Hepatitis B Screening entry
• U.S. Preventive Services Task Force: Hepatitis B Virus Infection in Adolescents and Adults, Screening (December 15, 2020)

Checked September 27, 2026. This page explains published Medicare rules. It is not medical or insurance advice, does not say who should have this test, and cannot tell you whether your own test will be covered or what your bill will be; your doctor's office and Medicare can. ClaraCover has no relationship with any lab, provider, or plan.