← All guides

Does Medicare cover STI screening?

Yes, with conditions. Medicare Part B covers a screening for chlamydia, gonorrhea, syphilis, and hepatitis B once every 12 months, plus up to two counseling sessions a year, for people who are pregnant or who are sexually active and at increased risk. You pay nothing if the provider accepts assignment. The policy is specific about who qualifies, which tests it covers for women and for men, and where the test has to be ordered.

This page is about STI screening. For how often Medicare pays for blood work and other lab tests, see our free chart of Medicare's screening schedules.

What Medicare covers

Medicare.gov describes the benefit as "STI screenings for chlamydia, gonorrhea, syphilis, and/or hepatitis B." It covers the screening "if you're pregnant" or if you are a "sexually active adult at increased risk for an STI."

The same benefit includes counseling. Medicare.gov: "Up to 2 face-to-face, high-intensity behavioral counseling sessions. Each session can be 20-30 minutes long." The national coverage policy (NCD 210.10) puts it this way: "up to two individual 20- to 30-minute, face-to-face counseling sessions annually ... if referred for this service by a primary care physician or practitioner, and provided by a Medicare eligible primary care provider in a primary care setting."

Medicare's coding chart for this benefit marks it "Telehealth Eligible."

What "increased risk" means

Medicare.gov does not define increased risk. The coverage policy does. NCD 210.10 lists these:

• "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 years of age 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)"
• "In addition for men – men having sex with men (MSM)"

The policy took effect November 8, 2011, and its page says it was "last reviewed November 2011." The list has not changed since.

Which tests are covered for women, and which for men

The policy names each infection separately, and it does not treat women and men the same way. NCD 210.10:

• Chlamydia and gonorrhea. "Screening for chlamydia and gonorrhea: ... Women at increased risk for STIs annually."
• Syphilis. "Screening for syphilis: ... Men and women at increased risk for STIs annually."
• Hepatitis B. Under this policy, hepatitis B screening is for pregnant women only, at the first prenatal visit and again at delivery. Medicare's coding chart for the STI benefit says "See the Hepatitis B Screening service" for hepatitis B; that is a separate benefit with its own rules.

Medicare's coding chart states the frequency the same way: "Chlamydia, gonorrhea, and syphilis in women at increased risk but not pregnant, 1 screening per year / Syphilis in men at increased risk, 1 screening per year."

So the policy covers chlamydia and gonorrhea screening for women at increased risk, and it does not cover chlamydia and gonorrhea screening for men. This tracks the U.S. Preventive Services Task Force. Its chlamydia and gonorrhea recommendation (September 14, 2021) is a Grade B for women; for men, the task force issued an "I statement" rather than a Grade B. Its syphilis recommendation (September 27, 2022) is a Grade A and reads: "Screen for syphilis in persons at increased risk for infection." The task force's counseling recommendation (August 18, 2020) is a Grade B and does not set a number of sessions; the two-session limit is Medicare's.

Once every 12 months

Medicare.gov: "One STI screening every 12 months, or at certain times during pregnancy." The coverage policy says "annually" for each of the screenings it covers. Counseling is "Up to 2 behavioral counseling sessions a year."

Who has to order it, and where

This benefit has a setting rule that most lab tests do not. Medicare's coding chart says the patient is covered when a "Primary care provider refers them to a Medicare-eligible primary care provider in a primary care setting." The coverage policy uses the same words for counseling: "referred for this service by a primary care physician or practitioner, and provided by a Medicare eligible primary care provider in a primary care setting." Notice that Medicare.gov's cost sentence also says "primary care doctor or provider," not just "doctor."

What you pay

Medicare.gov: "You pay nothing if your primary care doctor or provider accepts assignment." Medicare's coding chart says the same thing in billing language: "No copayment, coinsurance, or deductible."

The codes

For anyone reading a bill or an order: the screening codes on Medicare's chart are 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, and 87800 for chlamydia; 87590, 87591, 87850, and 87800 for gonorrhea; 0402U, 0455U, and 87494 for a combined chlamydia and gonorrhea test; 86592, 86593, and 86780 for syphilis; and G0445 for the counseling session. The claim pairs Z11.3 with one of Z72.51, Z72.52, Z72.53, or Z72.89; the pregnancy rows add Z34.x or O09.9x codes.

The one change for 2026: the combined code 87494 was added effective January 1, 2026 (CMS transmittal R13709CP, April 2, 2026). The chart says "Don't report 87494 with 87491 or 87591." There was no change to who qualifies.

Before you go

This is ClaraCover's checklist, built from the rules above. Four questions for the office.

1. "Is this being ordered as an STI screening, and is the risk factor noted in my chart?" The claim pairs the screening code Z11.3 with a risk code (Z72.51, Z72.52, Z72.53, or Z72.89).
2. "When was my last covered STI screening?" Medicare pays for one every 12 months.
3. "Is my primary care provider ordering this, and is the visit in a primary care setting?" Both are conditions of the benefit.
4. "Does the provider accept assignment?" That is the condition for paying nothing. If counseling is included, ask whether this is one of your two sessions for the year.

Sources

• Medicare.gov: Sexually transmitted infection screenings & counseling
• CMS: National Coverage Determination 210.10, Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs (effective November 8, 2011)
• CMS: Medicare Preventive Services educational tool (MLN006559, July 2026), STI screening and counseling entry
• CMS: Transmittal R13709CP (April 2, 2026), adding CPT 87494 effective January 1, 2026
• U.S. Preventive Services Task Force: Chlamydia and Gonorrhea, Screening (September 14, 2021); Syphilis Infection, Screening (September 27, 2022); Sexually Transmitted Infections, Behavioral Counseling (August 18, 2020)

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