HPV Screening
The Centers for Medicare & Medicaid Services (CMS) has added Human Papillomavirus (HPV) testing to the list of Medicare covered preventive services, under specific conditions. The Conditions for Coverage are CMS will cover screening for cervical cancer with HPV testing once every 5 years as a preventive service benefit under Medicare for asymptomatic patients age 30 to 65 years in conjunction with the Pap smear test.
Coding of HPV Screening:
The Centers of Medicare and Medicaid Services has created a new code to report this service:
? A new Healthcare Common Procedure Coding System(HCPCS) code,G0476(HPV combo assay,CA screen),Type of Service(TOS) 5 (Diagnostic lab),has been created for this benefit.
? 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. As cervical cancer screening is a preventive service, no beneficiary coinsurance or deductible applies to claim lines containing HCPCS G0476
? The Centers of Medicare and Medicaid Services have also stated that Part B Medicare Administrative Contractors (MAC) shall only accept claims with a Place of Service Code equal to ’81’, Independent Lab or ’11’, Office and claims with dates of service on or after July 9,2015, MACs shall deny line-items on claims containing HCPCS G0476, HPV screening, when reported more than once in a 5-year period.
? Claims with date of service on or after July, 9, 2015 will deny line-items on claims containing HCPCS G0476, HPV screening, when the beneficiary is less than 30 years of age or older than 65 years of age.
ICD-10-Coding for HPV Screening:
To support medical necessity of G0476,
? For dates of service before October 1, 2015 ? ICD-9 V73.81 Special screening examination for human papillomavirus (HPV) [as primary] and V72.31 Routine gynecological examination [as secondary]
? For dates of service on or after October 1, 2015 ? ICD-10 Z11.51 Encounter for screening for human papillomavirus (HPV) and Z01.411 Encounter for gynecological examination (general)(routine) with abnormal findings or Z01.419 Encounter for gynecological examination (general)(routine) without abnormal findings