Key facts for NCD 190.33
- Benefit category
- Diagnostic Laboratory Tests
- Effective date
- 11/25/2002
- Implemented 01/01/2003
- Transmittal
- Transmittal 17
- Versions published
- 1
- Manual chapter
- 190
- NCD Manual (Pub. 100-03)
- Lab edit list
- 202 covered ICD-10
- 245 non-covered
TL;DR
NCD 190.33 sets Medicare's national policy for hepatitis panel/acute hepatitis panel under the benefit category "Diagnostic Laboratory Tests", effective 11/25/2002 and implemented 01/01/2003. • To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis. As a laboratory NCD it carries a national ICD-10 edit list: 202 diagnosis codes support medical necessity and 245 are denied, applied automatically by every Medicare contractor to 1 procedure code.
Item or service described
This panel consists of the following tests:
• Hepatitis A antibody (HAAb), IgM Antibody;
• Hepatitis B core antibody (HBcAb), IgM Antibody;
• Hepatitis B surface antigen (HBsAg); and
• Hepatitis C antibody.
Hepatitis is an inflammation of the liver resulting from viruses, drugs, toxins, and other etiologies. Viral hepatitis can be due to one of at least five different viruses, designated Hepatitis A, B, C, D, and E. Most cases are caused by Hepatitis A virus (HAV), Hepatitis B virus (HBV), or Hepatitis C virus (HCV).
HAV is the most common cause of hepatitis in children and adolescents in the United States. Prior exposure is indicated by a positive IgG anti-HAV. Acute HAV is diagnosed by IgM anti-HAV, which typically appears within four weeks of exposure, and which disappears within three months of its appearance. IgG anti-HAV is similar in the timing of its appearance, but it persists indefinitely. Its detection indicates prior effective immunization or recovery from infection. Although HAV is spread most commonly by fecal-oral exposure, parenteral infection is possible during the acute viremia stage of the disease. After exposure, standard immune globulin may be effective as a prophylaxis.
HBV produces three separate antigens (surface, core, and e (envelope) antigens) when it infects the liver, although only hepatitis B surface antigen (HBsAg) is included as part of this panel. Following exposure, the body normally responds by producing antibodies to each of these antigens; one of which is included in this panel: hepatitis B surface antibody (HBsAb)-IgM antibody , HBsAg is the earlier marker, appearing in serum four to eight weeks after exposure, and typically disappearing within six months after its appearance. If HBsAg remains detectable for greater than six months, this indicates chronic HBV infection. HBcAb, in the form of both IgG and IgM antibodies, are next to appear in serum, typically becoming detectable two to three months following exposure. The IgM antibody gradually declines or disappears entirely one to two years following exposure, but the IgG usually remains detectable for life. Because HBsAg is present for a relatively short period and usually displays a low titer, a negative result does not exclude an HBV diagnosis. HBcAb, on the other hand, rises to a much higher titer and remains elevated for a longer period of time, but a positive result is not diagnostic of acute disease, since it may be the result of a prior infection. The last marker to appear in the course of a typical infection is HBsAb, which appears in serum four to six months following exposure, remains positive indefinitely, and confers immunity. HBV is spread exclusively by exposure to infected blood or body fluids; in the U.S., sexual transmission accounts for 30% to 60% of new cases of HBV infection.
The diagnosis of acute HBV infection is best established by documentation of a positive IgM antibody against the core antigen (HBcAb-IgM) and by identification of a positive hepatitis B surface antigen (HBsAg). The diagnosis of chronic HBV infection is established primarily by identifying a positive hepatitis B surface antigen (HBsAg) and demonstrating positive IgG antibody directed against the core antigen (HBcAb-IgG). Additional tests such as Hepatitis B e antigen (HBeAg) and Hepatitis B e antibody (HBeAb), the envelope antigen and antibody, are not included in the Hepatitis Panel, but may be of importance in assessing the infectivity of patients with HBV. Following completion of a HBV vaccination series, HBsAb alone may be used monthly for up to six months, or until a positive result is obtained, to verify an adequate antibody response.
HCV is the most common cause of post-transfusion hepatitis; overall HCV is responsible for 15% to 20% of all cases of acute hepatitis, and is the most common cause of chronic liver disease. The test most commonly used to identify HCV measures HCV antibodies, which appear in blood two to four months after infection. False positive HCV results can occur. For example, a patient with a recent yeast infection may produce a false positive anti-HCV result. For this reason, at present positive results usually are confirmed by a more specific technique. Like HBV, HCV is spread exclusively through exposure to infected blood or body fluids.
This panel of tests is used for differential diagnosis in a patient with symptoms of liver disease or injury. When the time of exposure or the stage of the disease is not known, a patient with continued symptoms of liver disease despite a completely negative Hepatitis Panel may need a repeat panel approximately two weeks to two months later to exclude the possibility of hepatitis. Once a diagnosis is established, specific tests can be used to monitor the course of the disease.
Indications and limitations of coverage
Indications
• To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis.
• Prior to and subsequent to liver transplantation.
Limitations
After a hepatitis diagnosis has been established, only individual tests, rather than the entire panel, are needed.
Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.33 version 1. View the original on cms.gov.
Laboratory NCD code lists (January 2026)
Medicare contractors apply this NCD through a national edit: the procedure codes below are paid only when the claim carries a covered diagnosis. The January 2026 list holds 202 covered and 245 non-covered ICD-10-CM codes plus 9 codes with other resolution rules.
1 procedure code are edited against this NCD's diagnosis list. CPT codes are shown as numbers only; descriptors are licensed by the AMA.
| Code | Code set |
|---|---|
| 80074 | CPT (descriptor licensed by AMA) |
The first 40 of 202 covered diagnosis codes, with FY2027 ICD-10-CM descriptions. A claim with any covered code on the line supports medical necessity under the national edit.
| ICD-10-CM | Description | Effective |
|---|---|---|
| A925 | Zika virus disease | 2016-10-01 |
| B150 | Hepatitis A with hepatic coma | 2015-10-01 |
| B159 | Hepatitis A without hepatic coma | 2015-10-01 |
| B160 | Acute hepatitis B with delta-agent with hepatic coma | 2015-10-01 |
| B161 | Acute hepatitis B with delta-agent without hepatic coma | 2015-10-01 |
| B162 | Acute hepatitis B without delta-agent with hepatic coma | 2015-10-01 |
| B169 | Acute hepatitis B without delta-agent and without hepatic coma | 2015-10-01 |
| B170 | Acute delta-(super) infection of hepatitis B carrier | 2015-10-01 |
| B1710 | Acute hepatitis C without hepatic coma | 2015-10-01 |
| B1711 | Acute hepatitis C with hepatic coma | 2015-10-01 |
| B172 | Acute hepatitis E | 2015-10-01 |
| B178 | Other specified acute viral hepatitis | 2015-10-01 |
| B179 | Acute viral hepatitis, unspecified | 2015-10-01 |
| B180 | Chronic viral hepatitis B with delta-agent | 2015-10-01 |
| B181 | Chronic viral hepatitis B without delta-agent | 2015-10-01 |
| B182 | Chronic viral hepatitis C | 2015-10-01 |
| B188 | Other chronic viral hepatitis | 2015-10-01 |
| B189 | Chronic viral hepatitis, unspecified | 2015-10-01 |
| B190 | Unspecified viral hepatitis with hepatic coma | 2015-10-01 |
| B1910 | Unspecified viral hepatitis B without hepatic coma | 2015-10-01 |
| B1911 | Unspecified viral hepatitis B with hepatic coma | 2015-10-01 |
| B1920 | Unspecified viral hepatitis C without hepatic coma | 2015-10-01 |
| B1921 | Unspecified viral hepatitis C with hepatic coma | 2015-10-01 |
| B199 | Unspecified viral hepatitis without hepatic coma | 2015-10-01 |
| F1111 | Opioid abuse, in remission | 2017-10-01 |
| F1113 | Opioid abuse with withdrawal | 2020-10-01 |
| F1191 | Opioid use, unspecified, in remission | 2022-10-01 |
| F1213 | Cannabis abuse with withdrawal | 2020-10-01 |
| F1291 | Cannabis use, unspecified, in remission | 2022-10-01 |
| F1293 | Cannabis use, unspecified with withdrawal | 2018-10-01 |
| F1411 | Cocaine abuse, in remission | 2017-10-01 |
| F1413 | Cocaine abuse, unspecified with withdrawal | 2020-10-01 |
| F1491 | Cocaine use, unspecified, in remission | 2022-10-01 |
| F1493 | Cocaine use, unspecified with withdrawal | 2020-10-01 |
| F1511 | Other stimulant abuse, in remission | 2017-10-01 |
| F1513 | Other stimulant abuse with withdrawal | 2020-10-01 |
| F1591 | Other stimulant use, unspecified, in remission | 2022-10-01 |
| G933 | — | 2015-10-01 |
| G9331 | Postviral fatigue syndrome | 2022-10-01 |
| G9332 | Myalgic encephalomyelitis/chronic fatigue syndrome | 2022-10-01 |
245 diagnosis codes deny automatically under this NCD; the first 20 are shown.
| ICD-10-CM | Description |
|---|---|
| R99 | Ill-defined and unknown cause of mortality |
| Z0000 | Encounter for general adult medical examination without abnormal findings |
| Z0001 | Encounter for general adult medical examination with abnormal findings |
| Z00110 | Health examination for newborn under 8 days old |
| Z00111 | Health examination for newborn 8 to 28 days old |
| Z00121 | Encounter for routine child health examination with abnormal findings |
| Z00129 | Encounter for routine child health examination without abnormal findings |
| Z005 | Encounter for examination of potential donor of organ and tissue |
| Z006 | Encounter for examination for normal comparison and control in clinical research program |
| Z0070 | Encounter for examination for period of delayed growth in childhood without abnormal findings |
| Z0071 | Encounter for examination for period of delayed growth in childhood with abnormal findings |
| Z008 | Encounter for other general examination |
| Z020 | Encounter for examination for admission to educational institution |
| Z021 | Encounter for pre-employment examination |
| Z022 | Encounter for examination for admission to residential institution |
| Z023 | Encounter for examination for recruitment to armed forces |
| Z024 | Encounter for examination for driving license |
| Z025 | Encounter for examination for participation in sport |
| Z026 | Encounter for examination for insurance purposes |
| Z0271 | Encounter for disability determination |
Revision history
07/2004 - Published NCD in the NCD Manual without change to narrative contained in PM AB-02-110. Coding guidance now published in Medicare Lab NCD Manual. Effective and Implementation dates NA. ( TN 17 ) (CR 2130)
07/2002 - Implemented NCD. Effective date 11/25/02. Implementation date 1/01/03. ( TN AB-02-110 ) (CR 2130)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 190.33
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 190.33
What does NCD 190.33 cover?
• To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.33 take effect?
The current version (1) is effective 11/25/2002, implemented 01/01/2003, published in transmittal 17. This is the only published version.
Does a Local Coverage Determination override NCD 190.33?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Which diagnosis codes are covered under NCD 190.33?
The January 2026 laboratory NCD edit list contains 202 ICD-10-CM codes that support hepatitis panel/acute hepatitis panel (for example A925 Zika virus disease; B150 Hepatitis A with hepatic coma; B159 Hepatitis A without hepatic coma) and 245 codes that deny. The list applies to 80074.
How often does the lab NCD code list for 190.33 change?
CMS updates the laboratory NCD edit module quarterly, with the January release carrying the annual ICD-10-CM code changes. Codes added or deleted mid-year appear in the quarterly change spreadsheets on the Lab NCDs page.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
- Laboratory NCD ICD-10 code lists, January 2026Version January 2026 · effective 2026-01-01 · file 2026100-Initial-ICD10-NCD-Spreadsheet-20250721-508.xlsxSHA-256 57ff5cd37ba523d3…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.