CMS opens HCV screening NCD 210.13 reconsideration (CAG-00436R); comments through Oct 23

On September 23, 2026, the Centers for Medicare & Medicaid Services posted the NCA tracking sheet for CAG-00436R, *Screening for Hepatitis C Virus (HCV) in Adults*, opening a formal reconsideration of NCD 210.13. The companion NCA page (ncaid=325) is open for public comment through October 23, 2026.

If your desk bills preventive HCV screening under Medicare Part B, this is a watch item: the coverage NCD is under reconsideration, the comment clock is live, and no new ages, intervals, place-of-service rules, or HCPCS have been finalized yet.

What CMS opened

CMS accepted five complete formal requests and initiated review on September 23, 2026. Status on the tracking sheet is Open. Benefit category listed for the analysis is Additional Preventive Services. Contact listed on the sheet is the CAG Resource Box at CAGinquiries@cms.hhs.gov.

Named requestors on the tracking sheet include Carl Schmid (HIV+Hepatitis Policy Institute, with co-signers); Lee H. Hilborne, MD (Quest Diagnostics); Joshua Riel (Cleveland Clinic Foundation Revenue Cycle Management); Lisa Satterfield (ACOG); and Sarah Harm, MD (University of Vermont Medical Center Pathology).

What NCD 210.13 covers today

Until a proposed or final decision memo changes it, current coverage still follows NCD 210.13. CMS covers FDA-approved/cleared laboratory HCV screening tests, used consistent with FDA labeling and CLIA rules, when ordered by the beneficiary's primary care physician or practitioner in a primary care setting, for beneficiaries who meet either:

• High risk: current or past illicit injection drug use; or history of blood transfusion prior to 1992. Repeat screening for high-risk persons is covered annually only for persons with continued illicit injection drug use since the prior negative screening test.
• Birth cohort: a single screening test for adults born 1945 through 1965 who do not meet the high-risk definition.

Primary care setting and primary care physician/practitioner definitions in the NCD still apply. Do not invent expanded ages, annual intervals for the birth cohort, or non-primary-care place-of-service coverage from this NCA alone.

What the reconsideration may examine

The tracking sheet says the analysis will align with the requests and focus on screening for HCV infection in adults aged 18 to 79 years, as recommended by the USPSTF. CMS says it is particularly interested in peer-reviewed literature on:

• the specific screening interval for persons who continue to be at risk for new HCV infection; and
• screening in non-primary care settings.

That is the analysis scope CMS published. It is not yet a coverage change. A proposed decision memo is the next formal document that would state proposed policy language.

Timeline and current vs. reconsideration scope

What this is not

• Not a final coverage rewrite. No decision memo has issued.
• Not a HCPCS or claim-edit code change. Existing billing clarifications on the NCD page (including the February 2026 CR 14388 / G0567 billing-history note) are separate background; this story is the reconsideration open, not a new code instruction.
• Not the live January 2027 laboratory NCD edit software story (CR 14614 / lab NCDs 190.12-190.34).
• Not the live NCD 210.3 ColoSense 0421U colorectal screening coverage update.
• Not an NCCI PTP/AOC file update.

Look up related ICD-10-CM descriptors in the encoder when documentation language is unclear. Compare nearby diagnosis options in Compare. Browse other CMS Watch items on /news.