Medicare adds Human Papillomavirus (HPV) Testing to Medicare covered preventive services
Under specific conditions, The Centers for Medicare & Medicaid Services (CMS) has added Human Papillomavirus (HPV) testing to the list of Medicare covered preventive services.
What are the conditions for Coverage:
Under Medicare for asymptotic patients age 30 to 65 years old, with a Pap smear, The Centers for Medicare and Medicaid Services(CMS) will cover screening for cervical cancer with HPV testing once every 5 years as a preventive service benefit.
While coding claims:
CMS has created a new code to report this service:
Labs (Place of service 81 Independent laboratory or 11 Office) may report HCPCS Level II G0476 HPV combo assay, CA screen effective July 9, 2015.
This code will be priced by Medicare administrative contractors for claims with dates of service between July 9, 2015 to December 31, 2016.
Beginning January 1, 2017, G0476 will be priced and paid according to the Clinical Laboratory Fee Schedule. No coinsurance or deductible applies,as cervical cancer screening is a preventive service.
To support medical necessity of G0476, appropriate diagnosis coding for ICD 9 and ICD10 is:
- For dates of service before October 1, 2015 ?
- ICD-9 code V73.81 will be used for Special screening examination for human papillomavirus (HPV)as primary.
- ICD-9 code V72.31 will be used for Routine gynecological examinationas secondary.
- For dates of service on or after October 1, 2015 ?
- ICD-10 code 51 will be used for Encounter for screening for human papillomavirus (HPV)
- ICD-10 code Z01.411 will be used for Encounter for gynecological examination (general)(routine) with abnormal findingsOR
- ICD-10 code Z01.419 will be used for Encounter for gynecological examination (general)(routine) without abnormal findings.