Prior Authorization Review Panel MCO Policy Submission

Transcription

1 Prior Authorization Review Panel MCO Policy Submission A separate copy of this form must accompany each policy submitted for review. Policies submitted without this form will not be considered for review. Plan: Aetna Better Health Submission Date: 11/01/2018 Policy Number: 0835 Policy Name: Hepatitis Screening Effective Date: Revision Date: Type of Submission Check all that apply: New Policy Revised Policy* Annual Review No Revisions *All revisions to the policy must be highlighted using track changes throughout the document. Please provide any clarifying information for the policy below: CPB 0835 Hepatitis Screening Clinical content was last revised 12/09/2016. Additional non-clinical updates were made by Corporate since the last PARP submission, as documented below. Revision and Update History since last PARP submission: 12/06/ This CPB has been updated with additional references. 09/27/2018 Next tentative scheduled review date by Corporate. Name of Authorized Individual (Please type or print): Signature of Authorized Individual: Dr. Bernard Lewin, M.D. Updated 12/06/2017

2 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 1 of 20 --> ( Hepatitis Screening Number: 0835 *Please see amendment for Pennsylvania Medicaid at the end of this CPB. Policy Aetna considers hepatitis B virus (HBV) screening medically necessary for the following individuals: Current or former hemodialysis individuals Donors of blood, plasma, organs, tissues, or semen Household, needle-sharing, or sexual contacts of persons known to be HBV-positive Individuals born in Asia, Africa, and other geographic regions with a 2 % or higher prevalence of chronic HBV infection Infants born to HBV infected mothers Individuals with chronically elevated amino alanine transferase (ALT) or aspartate amino transferase (AST) of unknown etiology Individuals with HIV Injection drug users Men who have sexual contact with men Persons needing immunosuppressive therapy, including chemotherapy, immunosuppression related to organ transplantation, and immunosuppression for rheumatologic or gastroenterologic disorders Policy His tory Last Review 12/06/2017 Effective: 12/07/2012 Next Review: 09/27/2018 Review History Definitions A dditiona l In form at ion Clinical Policy Bulletin Notes

3 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 2 of 20 Persons who are the sources of blood or body fluids resulting in an exposure (e.g., needlestick, sexual assault) that might require post-exposure prophylaxis Pregnant women U.S. born persons not vaccinated as infants whose parents were born in regions with high HBV endemicity (greater than or equal to 8 %), such as sub-saharan Africa, southeast and central Asia, and China. Aetna considers hepatitis C virus (HCV) screening medically necessary for the following individuals: Children born to HCV infected mothers Children from a region with high prevalence of HCV infection. Current or former hemodialysis individuals Individuals who received blood transfusions or organ transplants prior to July, 1992 or who received blood from a donor who later tested positive for HCV infection Individuals who received clotting factor concentrates produced before 1987 Individuals with HIV Individuals with persistently abnormal ALT levels Individuals with a recognized exposure such as health care workers, emergency medical personnel or public safety workers after needle sticks, sharps or mucosal exposures to HCV positive blood Injection drug users Present sexual partners of HCV-infected persons Aetna considers one-time testing without prior ascertainment of HCV risk medically necessary for persons born between 1945 to1965. See also: CPB Hepatitis A Vaccine (../1_99/0048.html), CPB Hepatitis B Vaccine (../400_499/0410.html).

4 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 3 of 20 Background Hepatitis refers to inflammation of the liver and also refers to a group of viral infections that affect the liver. The most common types are Hepatitis A, Hepatitis B, and Hepatitis C, although Hepatitis D and E viruses have also been identified. An estimated 4.4 million Americans are living with chronic hepatitis, the majority of whom do not know they are infected. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation (CDC Division of Viral Hepatitis, 2012). Transmission of hepatitis A, which is caused by hepatitis A virus (HAV), occurs by the fecal-oral route through direct contact with an HAV-infected person or by ingestion of HAVcontaminated food or water. Foodborne or waterborne hepatitis A outbreaks are relatively uncommon in the United States, but food handlers with hepatitis A are frequently identified, and evaluation of the need for immunoprophylaxis and implementation of control measures are a considerable burden on public health resources. It is also notable that HAVcontaminated food may be the source of hepatitis A for an unknown proportion of persons whose source of infection is not identified (Fiore, 2004). Torner et al (2012) reported that although hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. They investigated the association between duration and characteristics of hepatitis A outbreaks reported between 1991 and An outbreak was defined as greater than or equal to 2 epidemiologically-linked cases with greater than or equal o 1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Between 1991 and 2007, 268 outbreaks (rate 2.45 per million persons-year) and 1,396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95 % confidence interval [CI]: 0.94 to 0.98) and school setting (OR = 0.39; 95 % CI: 0.16 to 0.92).

5 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 4 of 20 However, the authors also noted that in person-to-person transmission outbreaks, only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95 % CI: 0.95 to 0.98). Torner et al concluded that making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration. Wiersma et al (2011) reported that most of the estimated 350 million people with chronic hepatitis B virus (HBV) live in resource-constrained settings and that up to 25 % of those persons will die prematurely of hepatocellular carcinoma or cirrhosis. They further state that an informal World Health Organization consultation of experts concluded that chronic HBV is a major public health problem in emerging nations, all HIV-infected persons should be screened for HBV infection, HIBV/HBV co-infected persons should be treated with therapies active against both viruses and that reduce the risk of resistance, and that standards for the management of chronic HBV infection should be adapted to resourceconstrained settings. Hepatitis B, which is caused by infection with the HBV, is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood. In adults, approximately half of newly acquired HBV infections are symptomatic, and approximately 1 % of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at infection, with approximately 90 % of infected infants and 3 0% of infected children aged less than 5 years becoming chronically infected, compared with 2 % to 6 % of adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma is 15 % to 25 %. The primary risk factors that have been associated with infection are unprotected sex with an infected partner, birth to an infected mother, unprotected sex

6 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 5 of 20 with more than one partner, men who have sex with other men, history of other sexually transmitted diseases, and illegal injection drug use (CDC Division of Viral Hepatitis, 2012). The United States Preventive Services Task Force (USPSTF) strongly recommends screening for HBV in pregnant women at their first prenatal visit. The USPSTF recommends against routinely screening the general asymptomatic population for chronic HBV infection (USPSTF, 2004). Weinbaum et al (2009) reported that early identification of persons with chronic HBV infection enables infected persons to receive necessary care to prevent or delay onset of liver disease, and enables the identification and vaccination of susceptible household contacts and sex partners, interrupting ongoing transmission. The authors emphasized that testing had been recommended previously to enable primary prevention of HBV infection among close contacts for pregnant women, household contacts and sex partners of HBV-infected persons, persons born in countries with hepatitis B surface antigen (HBsAg) prevalence of more than 8 %, persons who are the source of blood or body fluid exposures that might warrant post-exposure prophylaxis (e.g., needlestick injury to a healthcare worker or sexual assault), and to enable appropriate treatment for infants born to HBsAg-positive mothers and persons infected with human immunodeficiency virus. With the increasing availability of efficacious hepatitis B treatment, the CDC published updated recommendations for public health evaluation and management for chronically infected persons and their contacts which extended testing recommendations to include persons born in geographic regions with HBsAg prevalence of greater than 2 %, men who have sex with men, and injection drug users. The CDC, in collaboration with the New York City (NYC) Department of Health and Mental Hygiene (DOHMH), conducted a chronic HBV surveillance, selecting a random sample of newly reported cases and collecting more detailed information from the patients' clinicians. Analysis was

7 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 6 of 20 presented on 180 randomly selected HBV cases reported during June 2008 to November Approximately twothirds (67 %) of the patients were Asian, and the most commonly reported reason for HBV testing was the patient's birth country or race/ethnicity (27 %). In 70 % of cases, the clinician did not know of any patient risk factors and 62 % did not know their patient's hepatitis A vaccination status despite recommendations. Sixty-nine percent of clinicians stated that they counseled their patients about notifying close contacts about their infection, and 75 % counseled about transmission and prevention. This surveillance effort provided quantitative data on health disparities, illustrating that not all patients received recommended prevention and treatment services. In response to these findings, DOHMH now routinely distributes HBV patient education materials to populations in need (CDC, 2012). HCV infection is the most common chronic bloodborne infection in the United States, with approximately 3.2 million persons chronically infected. Sixty to 70 % of persons newly infected with HCV typically are asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1 to 3 weeks after exposure, the average time from exposure to antibody to HCV (anti-hcv) seroconversion is 8 to 9 weeks, and anti-hcv can be detected in greater than 97 % of persons by 6 months after exposure. Chronic HCV infection develops in 70 % to 85 % of HCV-infected persons and 60 % to 70 % of chronically infected persons have evidence of active liver disease. Although the majority of infected persons may not be aware of their infection, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection occurs. HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through transfusion of blood from unscreened donors or through use of injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV (CDC Division of Viral Hepatitis, 2012).

8 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 7 of 20 Denniston et al (2012) discussed that many persons infected with hepatitis C virus (HCV) are unknown to the healthcare system because they may be asymptomatic for years, have not been tested for HCV infection, and only seek medical care when they develop liver-related complications. The authors analyzed data from persons who tested positive for past or current HCV infection during participation in the National Health and Nutrition Examination Survey (NHANES) during the years 2001 through They conducted a follow-up survey 6 months after examination to determine (i) how many participants testing positive for HCV infection were aware of their HCV status before being notified by NHANES, (ii) what actions participants took after becoming aware of their first positive test, and (iii) participants' knowledge about hepatitis C. Of the 30,140 participants tested, 393 (1.3 %) had evidence of past or current HCV infection and 170 (43 %) could be contacted during the follow-up survey and interviewed. Only 49.7 % were aware of their positive HCV infection status before being notified by NHANES and only 3.7 % of these respondents reported that they had first been tested for HCV because they or their doctor thought they were at risk for infection. The study results showed that, overall, 85.4 % had heard of hepatitis C and that correct responses to questions about hepatitis C were higher among persons 40 to 59 years of age, white non-hispanics, and respondents who saw a physician after their first positive HCV test. Eighty percent of respondents indicated they had seen a doctor about their first positive HCV test result. The investigators concluded that these data indicated that fewer than 50 % of those infected with HCV may be aware of their infection. The findings suggest that more intensive efforts are needed to identify and test persons at risk for HCV infection. Smith et al (2012) reported that many of the 2.7 to 3.9 million persons living with HCV infection, an increasing cause of morbidity and mortality in the United States, are unaware they are infected and do not receive care (e.g., education,

9 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 8 of 20 counseling, and medical monitoring) and treatment. The CDC estimates that although persons born between 1945 to1965 comprise an estimated 27 % of the population, they account for approximately three-fourths of all HCV infections in the United States, 73 % of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCVrelated liver disease. The CDC is augmenting previous recommendations for HCV testing to recommend one-time testing without prior ascertainment of HCV risk for persons born during 1945 to1965. These recommendations do not replace previous guidelines for HCV testing that are based on known risk factors and clinical indications, but rather define an additional target population for testing: persons born during 1945 to The CDC developed these recommendations with the assistance of a work group representing diverse expertise and perspectives. The recommendations are informed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, an approach that provides guidance and tools to define the research questions, conduct the systematic review, assess the overall quality of the evidence, and determine the strength of the recommendations. The United States Centers for Disease Control currently has in place recommendations regarding screening for both hepatitis B and hepatitis C. The USPSTF (Moyer, 2013) recommended screening for HCV infection in persons at high risk for infection. The USPSTF also recommended offering 1-time screening for HCV infection to adults born between 1945 and (B recommendation). The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) s practice guidelines on Diagnosis and management of hepatitis C infection in infants, children, and adolescents (Mack et al, 2012) noted that children from a region with high prevalence of HCV infection as well as present sexual partners of HCV-infected persons should be screened for HCV infection.

10 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 9 of 20 Updated USPSTF recommendations on screening for HBV were published in May, These recommendations are based on current evidence on the benefits and harms of antiviral therapy, the benefits of education on behavior change counseling, and the association between improvements in intermediate and clinical outcomes after antiviral therapy. The recommendation updates are focused on high-risk populations and reflect current evidence the USPSTF identified that HBV vaccination is effective for decreasing disease acquisition in high-risk populations. The risk for HBV infection varies substantially by country of origin in foreign-born persons in the United States (US), particularly persons born in countries with a prevalence of HBV infection of 2% or greater. The recommendations further note that lack of vaccination in infancy in US-born persons with parents from a country or region with high prevalence ( 8%). including sub-saharan Africa, central and southeast Asia, and China, is an important risk factor (USPSTF, 2014). The Centers for Medicare and Medicaid (CMS) issued a National Coverage Determination on June 2, 2014 stating that "the evidence is adequate to conclude that screening for HCV, in accord with the USPSTF recommendations, is reasonable and necesasry for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or erolled under Part B." Therefore, CMS will cover screening for HCV for beneficiaries who are adults at high risk for HCV infection, high risk being defined as a current or past history of illicit injection drug use or a history of receiving blood transfusion prior to 1992, CMS will also cover a single screening test for adults who do not meet the CMS definition of high risk, but who were born from 1945 through Hwang et al (2015) provided a revised opinion on Hepatitis B virus screening for patients with cancer before therapy based on the American Society of Clinical Oncology (ASCO) panel s consensus opinion in the context of an evolving database. This

11 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 10 of 20 updated provisional clinical opinion introduced a risk-adaptive strategy to identify and treat patients with HBV infection to reduce their risk of HBV re-activation. Medical providers should screen by testing patients for HBV infection before starting anti-cd20 therapy or hematopoietic cell transplantation. Providers should also screen patients with risk factors for HBV infection. Screening should include both hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-hbc), because re-activation can occur in patients who are HBsAg positive/anti-hbc positive or HBsAg negative/anti-hbc positive. Either total anti-hbc or anti-hbc immunoglobulin G (not immunoglobulin M) test should be used. Clinicians should start anti-viral therapy for HBsAgpositive/anti-HBc positive patients before or contemporaneously with cancer therapy and monitor HBsAgnegative/anti-HBc positive patients for re-activation with HBV DNA and ALT levels, promptly starting anti-virals if reactivation occurs. Clinicians can initiate anti-virals for HBsAgnegative/anti-HBc positive patients anticipating cancer therapies associated with a high risk of re-activation, or they can monitor HBV DNA and ALT levels and initiate on-demand anti-virals. For patients who neither have HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation, current evidence does not support HBV screening before initiation of cancer therapy. The ASCO panel suggests HBV screening for patients with cancer and HBV risk factors before initiation of systemic cancer therapy. Risk groups include the following: Persons born in countries and regions with prevalence of HBV infection greater than or equal to 2 % US-born persons not vaccinated as infants whose parents were born in regions with high prevalence of HBV infection (greater than or equal to 8 %; e.g., sub- Saharan Africa, southeast and central Asia) HIV-positive persons

12 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 11 of 20 Injection drug users Men who have sex with men Those with household or sexual contact with persons with HBV infection The American Gastroenterological Association (AGA) s guideline on The prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy (Reddy et al, 2015) recommended screening for HBV (HBsAg and anti- HBc, followed by a sensitive HBV DNA test if positive) in patients at moderate or high risk who will undergo immunosuppressive drug therapy. The AGA recommended against routinely screening for HBV in patients who will undergo immunosuppressive drug therapy and are at low risk. The Centers for Medicare and Medicaid Services (CMS, 2016) has determined that a screening test is covered for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection. "High risk" is defined as persons born in countries and regions with a high prevalence of HBV infection (i.e., 2%), U.S.-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. In addition, 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. CMS (2016) has stated that a screening test at the first prenatal visit is covered for pregnant women and then rescreening at time of delivery for those with new or continuing risk factors. In addition, CMS has determined that screening during the first prenatal visit would be appropriate for each

13 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 12 of 20 pregnancy, regardless of previous hepatitis B vaccination or previous negative hepatitis B surface antigen (HBsAg) test results. A ppendix Geographic regions with an HBsAg prevalence 2% * Region Countries Africa Asia Australia and South Pacific Middle East Eastern Europe Western Europe North America Mexico and All All All except Australia and New Zealand All except Cyprus and Israel All except Hungary Malta, Spain, and indigenous populations in Greenland Alaska natives and indigenous populations in northern Canada Guatemala and Honduras Central America South America Caribbean Ecuador, Guyana, Suriname, Venezuela, and Amazonian areas of Bolivia, Brazil, Colombia, and Peru Antigua and Barbuda, Dominica, Grenada, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, and Turks and Caicos Islands Adapted from Weinbaum et al, 2008.

14 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 13 of 20 * Estimates of prevalence of HBsAg, a marker of chronic hepatitis B virus infection, are based on limited data and might not reflect current prevalence in countries that have implemented childhood hepatitis B vaccination. In addition, HBsAg prevalence might vary within countries by subpopulation and locality. The regions with the highest prevalence (>5%) are sub- Saharan Africa and central and southeast Asia. A complete list of countries in each region is available at the CDC s Vaccines. Medicines. Advice webpage. Asia includes three regions: Southeast Asia, east Asia, and northern Asia. CPT Codes / HCPCS Codes / ICD-10 Codes Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+": Code Code Description Hepatitis B Virus (HBV) screening: CPT codes covered if selection criteria are met: Hepatitis B core antibody (HBcAb); total IgM antibody Hepatitis B surface antibody (HBsAb) Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) hepatitis B surface antigen (HBsAg) neutralization HCPCS codes covered if selection criteria are met:

15 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 14 of 20 Code Code Description G0499 Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to hbsag (anti-hbs) and hepatitis b core antigen (anti-hbc) ICD-10 codes covered if selection criteria are met: B20 Human immunodeficiency virus [HIV] disease B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere F Opioid related disorders [injecting drug users] F11.99 F F13.99 F Sedative, hypnotic, or anxiolytic related disorders [injecting drug users] Cocaine related disorders [injecting drug users] F14.99 F F15.99 O O16.9 O O29.93 Other stimulant related disorders [injecting drug users] Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium Other maternal disorders predominantly related to pregnancy R74.0 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH][ALT or AST] Z20.2 Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission Z20.5 Contact with and (suspected) exposure to viral hepatitis

16 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 15 of 20 Code Code Description Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus [HIV] Z21 Asymptomatic human immunodeficiency virus [HIV] infection status Z22.4 Carrier of infections with a predominantly sexual mode of transmission Z Carrier of viral hepatitis Z22.59 Z Encounter for supervision of normal pregnancy Z34.93 Z51.11 Encounter for antineoplastic chemotherapy Z High-risk sexual behavior Z72.53 Z Transplanted organ and tissue status Z94.9 Z99.2 Dependence on renal dialysis Hepatitis C Virus (HCV) screening: CPT codes covered if selection criteria are met: Hepatitis C antibody Confirmatory test (eg, immunoblot) HCPCS codes covered if selection criteria are met: G0472 Hepatitis C antibody screening for individual at high risk and other coverage indication(s) ICD-10 codes covered if selection criteria are met (not all inclusive): B20 Human immunodeficiency virus [HIV] disease B97.35 Human immunodeficiency virus, type II [HIV-2]

17 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 16 of 20 Code Code Description D65 - Coagulation defects, purpura and other D69.9 hemorrhagic conditions F Opioid related disorders [injecting drug users] F11.99 F F13.99 F Sedative, hypnotic, or anxiolytic related disorders [injecting drug users] Cocaine related disorders [injecting drug users] F14.99 F F15.99 T80.61X+ Other stimulant related disorders [injecting drug users] Other serum reaction due to administration of blood products [Blood transfusion, without reported diagnosis] Z20.5 Contact with and (suspected) exposure to viral hepatitis Z Carrier of viral hepatitis Z22.59 Z Transplanted organ or tissue status Z94.9 Z99.2 Dependence on renal dialysis The above policy is based on the following references: 1. Fiore AE. Hepatitis A transmitted by food. Clinical Infectious Diseases. 2004;38: US Preventive Services Task Force (USPSTF). Screening for hepatitis B infection, topic page. Rockville, MD: U.S. Preventive Services Task Force; Available at:

18 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 17 of 20 Accessed August 28, Weinbaum CM, Mast EE, Ward JW. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. Hepatology. 2009;49(5 Suppl):S35-S Wiersma ST, McMahon B, Pawlotsky JM, et al. Treatment of chronic hepatitis B virus infection in resource-constrained settings: Expert panel consensus. Liver Int. 2011;31(6): Centers for Disease Control and Prevention (CDC). Surveillance for chronic hepatitis B virus infection - New York City, June 2008-November MMWR Morb Mortal Wkly Rep. 2012;61(1): CDC Division of Viral Hepatitis. Viral Hepatitis. Atlanta, GA: Centers for Disease Control and Prevention; Available at: Accessed August 23, Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey Hepatology. 2012;55 (6): Smith BD, Morgan RL, Beckett GA. Recommendations for the identification of chronic hepatitis C virus infection among persons born during MMWR Recomm Rep. 2012;61(RR-4): Torner N, Broner S, Martinez A, et al. Factors associated to duration of hepatitis a outbreaks: Implications for control. PLoS One. 2012;7(2):e Mack CL, Gonzalez-Peralta RP, Gupta N, et al. NASPGHAN practice guidelines: Diagnosis and management of hepatitis C infection in infants, children, and adolescents. J Pediatr Gastroenterol Nutr. 2012;54(6):

19 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 18 of Moyer VA; U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(5): Weinbaum CM, Williams I, Mast EE, et al. Centers for Disease Control and Prevention recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recommendations Report. 2008;57(RR-8): US Preventive Services Task Force (USPSTF). Screening for hepatitis B virus infection in nonpregnanat adolescents and adults: US Preventive Services Task Force recommendation statement. Rockville, MD: USPSTF;2014. Available at: Accessed June 2, Center for Medicare & Medicaid Services (CMS). Screening for hepatitis C virus (HCV) in adults. Decision Memorandum # CAG-00436N. Baltimore, MD: CMS; June 2, Hwang JP, Somerfield MR, Alston-Johnson DE, et al. Hepatitis B virus screening for patients with cancer before therapy: American Society of Clinical Oncology provisional clinical opinion update. J Clin Oncol. 2015;33(19): Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148(1): van Rooijen M, Heijman T, de Vrieze N, et al. Earlier detection of hepatitis C virus infection through routine hepatitis C virus antibody screening of human immunodeficiency virus-positive men who have sex with men attending a sexually transmitted infection outpatient clinic: A longitudinal study. Sex Transm Dis. 2016;43(9):

20 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 19 of Centers for Medicare & Medicaid Services (CMS). Screening for hepatitis B virus (HBV) infection. Decision Memorandum #CAG-00447N. Baltimore, MD: CMS; September 28, Centers for Disease Control and Prevention. Vaccines. Medicines. Advice. Available at: Accessed august 16, Brady JE, Liffmann DK, Yartel A, et al. Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study. Hepatology. 2017;65(1): Federman AD, Kil N, Kannry J, et al. An electronic health record-based intervention to promote hepatitis C virus testing among adults born between 1945 and 1965: A cluster-randomized trial. Med Care. 2017;55 (6):

21 Hepatitis Screening - Medical Clinical Policy Bulletins Aetna Page 20 of 20 Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change. Copyright Aetna Inc.

22 AETNA BETTER HEALTH OF PENNSYLVANIA Amendment to Aetna Clinical Policy Bulletin Number: 0835 Hepatitis Screening Screening for Hepatitis B and C do not require prior authorization for the Pennsylvania Medical Assistance plan. Updated 12/06/2017