Age Eligibility Update for Cervical Screening for Apr. 2013

Effective for dates of service on or after May 1, 2013, the following cervical screening codes are restricted to women ages 21 through 65 regardless of sexual history:

Cytopathology…. 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88164, 88165, 88166, 88167, 88174 and 88175.

Reimbursement may be made for services provided to women younger than 21 years or over the age of 65 who have, or do not have, a cervix. However, the ordering provider must document on the laboratory order, and the laboratory provider must document in Box 19 of the claim that the woman meets one or more of the following:

• Received a diagnosis of a high-grade precancerous cervical lesion (cervical intraepithelial neoplasia [CIN] 2, CIN 3, or adenocarcinoma in situ [AIS]) within the past 20 years….
•  In utero exposure to diethylstilbestrol (DES).
• Immunocompromised status (such as HIV positive or immune suppressed such as a transplant patient using steroids).
• Requires repeat cervical cytology to reevaluate prior atypical squamous cells of undetermined significance (ASC-US)…..
•  Over the age of 65 who did not have adequate negative prior screening…..

Source: General Medicine | April 2013 | Bulletin 466