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Transforming health care through research and education.

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Leveraging research and education to create a society of healthy communities, where all individuals reach their highest potential for health.

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Overview of Cost and Reimbursement Issues

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Testing a patient for HIV is cost effective, when compared with the expense of treatment for HIV or AIDS. A 2006 study found the average lifetime cost of care from diagnosis for an HIV-infected adult is $618,900 over 24 years.

Following is a list of resources and issues for a hospital or clinic to consider in starting or expanding a routine HIV screening or diagnostic testing program.

Mission Compatibility

  • Consider how HIV screening may connect to the organization's mission pertaining to community health. Enhancing screening may make strategic sense for your institution. 
  • If HIV screening is conducted as part of community outreach, it may be eligible to be included in a hospital's community benefit report to the Internal Revenue Service.  For more information, consult with the person in your hospital who is responsible for community benefit reporting.  This person may work in the finance, community benefit, or community health departments.  For more information on community benefit reporting, click here.

Quality Improvement

  • Diagnosing an HIV-infected patient early results in lower treatment costs, avoidance of hospital readmission, a potential reduction in uncompensated care and fewer opportunistic infections. For more information on hospital readmissions, click here.
  • Given that many people in the U.S. who are infected with HIV are unaware of their status, diagnosing the infection can increase the likelihood of practicing precautionary behavior, thereby reducing the risk of transmitting the virus. HIV-infected persons who are unaware of their infection do not necessarily reduce risk behaviors.
  • Because medical treatment that lowers HIV viral load might also reduce risk for transmission to others, early referral to medical care could prevent HIV transmission in communities while reducing a person's risk for HIV-related illness or death.

Cited Sources

1. Schackman, B. Medical Care, November 2006; Vol 44: pp 990-997

Reimbursement Structures

  • Global, per diem or bundled payments may reduce spending and enhance quality, yet the structure of reimbursement makes it difficult to determine whether the cost of testing is covered by the lump sum paid for services.  Speak with a reimbursement specialist at your facility for clarification. For more information on bundled payments, click here.

Test Kits

  • The cost of tests is lowering, and conventional tests may cost less than rapid tests, depending on the purchasing contracts. 
  • Vendor discounts are available for bulk purchasing. For a summary of the undiscounted prices for FDA-approved rapid HIV test kits, please click here. For more information, speak with your purchasing or laboratory directors.
  • State and local health departments may provide test kits or staff to assist with testing, including laboratory services for confirmatory tests.  In addition, they may provide personnel for staff training or assistance contacting patients' sex or needle-sharing partners who may be at risk for HIV.
  • Some clinics, public hospitals and other disproportionate-share hospitals are eligible for 340b drug pricing, which sets an upper limit on the price that drug manufacturers receive from covered entities for outpatient drugs. For details, go here. For information on whether your facility qualifies, contact your pharmacy director.
  • Hospitals and providers may also engage in group-purchasing arrangements to reduce the cost of test kits.  For information, contact your laboratory or purchasing directors.


  • Coding guidelines for HIV testing produced by the American Medical Association and the American Academy of HIV Medicine are available by clicking here. Share this document with your medical staff as appropriate.

Insurance Coverage

  • Some states require third-party payers to reimburse providers for HIV screening. For information, contact your reimbursement specialist.
  • Many third-party payers reimburse clinics and providers for the cost of the tests and the time to perform them, counsel patients and link them to care.  Check with your payers or the reimbursement specialists at your facility for information on reimbursement.  A chart reviewing payer reimbursement for HIV screening and diagnostic testing can be found here.
  • The new health reform law, the Patient Protection and Affordable Care Act, requires that beginning in 2010 qualified health plans provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force (USPSTF).  For HIV, this includes screening for adolescents and adults at increased risk, and additional preventive care and screenings for women, according to the clinical considerations outlined here.
  • Beginning July 2010, the Centers for Medicare and Medicaid Services began covering HIV screening according to the clinical considerations adopted by the USPSTF.  For more information, click here.
  • As part of health reform's prevention and wellness provisions, some providers that conduct HIV screening may be eligible for a 1% increase in Federal Medical Assistance Percentage. For more information, go here.
  • Hospitals and come clinics may explore partnering with Federally Qualified Health Centers, which have enhanced funding for HIV testing and screening.

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