Cost & Reimbursement

These resources are provided to help a testing program determine how it will obtain and retain necessary funding. Because each provider and each funder is different, it is difficult to present precise cost and reimbursement information. However, the many issues presented serve as a framework for further research and discussion for any HIV testing program.

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Downloadable Resources
(Please right-click to download each resource.)

  1. HIV Testing Cost and Reimbursement (HRET, 2010)
    This package of information on HIV testing and screening, including cost and reimbursement tools,  will assist clinical managers and individual practitioners in starting or expanding an HIV screening or diagnostic testing program. The scope of these resources is limited to screening and testing, and does not explore linkage-to-care issues. This information is designed for health care providers who are not necessarily experts on HIV, finance or reimbursement, and serves as a guide to asking the right questions in each health system, hospital or clinic.
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  2. Coding Guide (AAHIVM, AMA 2010)
    This coding guide for routine HIV testing in health care settings addresses the changes in codes after the 2006 HIV testing guidelines came into effect, as well and examples for codes required by Medicaid and Medicare. Important contact information is also at the end of the guide.
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  3. Medicaid Coverage for HIV Testing (Kaiser, 2012)
    This fact sheet assesses coverage of routine HIV screening by state Medicaid programs. Medicaid is the largest source of care and coverage for people with HIV/AIDS in the United States. However, routine HIV screening is an optional Medicaid benefit which states may choose to cover.
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  4. Health Center Model (NACHC 2009)
    This document provides a model for how a community health center (CHC) can design a process where everyone 13 to 64 years of age is screened for HIV as a routine part of medical care. The tools and resources referenced were developed, tested, and successfully used by six community health centers participating in a Routine HIV Screening pilot supported by the Centers for Disease Control and Prevention (CDC).
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  5. Getting Started Checklist (East Bay AETC, 2008)
    This checklist was created to help you to think about all of the different issues to consider in implementing routine HIV testing.
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