Screening for Cervical Cancer for Human Papillomavirus (HPV) Screening

Services submitted for screening for cervical cancer with Human Papillomavirus (HPV) Testing have been reported incorrectly. Therefore, a billing and coding article (A58232) has been developed to provide guidance for these services. This new billing and coding article is consistent with National Coverage Determination (NCD) 210.2.1.

This new billing and coding article is effective for services rendered on or after June 4, 2020.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.

Consistent with National Coverage Determination (NCD) 210.2.1 screening HPV services are to be billed with Healthcare Common Procedure Coding System (HCPCS) code G0476. These services require dual diagnosis codes. The primary International Statistical Classification of Diseases and Related Health Problems, 10th revision, (ICD-10) code Z11.51 must be reported along with one of the following secondary ICD-10-CM diagnosis codes: Z01.411 or Z01.419.

It is incorrect to report these screening services with Current Procedural Terminology (CPT®) code 87624 [Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types].

Please refer to NCD 210.2.1 for complete information on screening for cervical cancer with Human Papillomavirus (HPV).

Source: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=58232&ver=3&DocID=A58232&SearchType=Advanced&bc=EAAAAAgAAAAA&