Screening for Cervical Cancer with Human Papillomavirus (HPV)

30.2.1 – Screening for Cervical Cancer with Human Papillomavirus (HPV) Testing (Rev. 3460, Issued: 02-05-16, Effective: 07-09-16, Implementation: 03-07-16 - for non-shared MAC edits; 07-05-16 - CWF analysis and design; 10-03-16 - CWF Coding, Testing and Implementation, MCS, and FISS Implementation; 01-03-17 - Requirement BR9434.04.8.2) See the Medicare National Coverage Determinations (NCD) Manual, Pub 100-03, Section 210.2.1 for complete coverage requirements for screening for cervical cancer with Human Papillomavirus testing (HPV). The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to add HPV testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate U.S. Food and Drug Administration (FDA)-approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations. Effective for claims with dates of service on or after July 9, 2015, payment may be made for HCPCS G0476 (cervical cancer screening, all-inclusive HPV co-test with cytology (Pap smear) to detect HPV DNA or RNA sequences). For claims with date of service from July 9, 2015 through December 31, 2016, HCPCS G0476 will be contractor priced. Beginning with date of service January 1, 2017 and after, HCPCS G0476 will be priced and paid according to the CLFS. G0476 will be included in the January 2017 CLFS, January 1, 2016 IOCE, the January 2016 OPPS and January 1, 2016 MPFSD. HCPCS G0476 will be effective retroactive to July 9, 2015 in the IOCE & OPPS. Effective for claims with dates of service on or after July 9, 2015, payment may be made for HCPCS G0476 (cervical cancer screening, all-inclusive HPV co-test with cytology (Pap smear) to detect HPV DNA or RNA sequences) only when submitted with a Place of Service Code equal to ‘81’, Independent Lab or ‘11’, Office. A. Screening Pap Smears: A/B MAC (B) Action for Submitting Claims to the Common Working File (CWF) and CWF Edit When a A/B MAC (B) receives a claim for a screening Pap smear, performed on or after January 1, 1998, it must enter a deductible indicator of 1 (not subject to deductible) in field 67 of the HUBC record. CWF will edit for screening pelvic examinations performed more frequently than allowed according to the presence of high risk factors.