Test Restrictions Update

New reimbursement requirements will be initiated for Human Papillomavirus (HPV) test code 87621 (infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). Reimbursement of HPV screening is supported for women who qualify to receive the following services:

• Follow-up of Low-grade Squamous Intraepithelial (LSIL) cytology result in women less than 21 years of age (HPV DNA testing at 12 months in lieu of cytology at six and 12 months is an option).
• Follow-up post colposcopy in women with Paps read as Atypical Squamous Cell, High Grade (ASC-H), LSIL, or HPV DNA positive Atypical Squamous Cells of Undetermined Significance (ASC-US) in whom Cervical Intraepithelial Neoplasia (CIN) is not identified at colposcopy (may be followed up at 12 months with HPV DNA testing in lieu of cytology at six and 12 months).
• Follow-up of women with biopsy proven CIN I (HPV DNA testing at 12 months in lieu of cytology at six and 12 months is an option).
• Follow-up in women post treatment of CIN II and III (HPV DNA testing at least six months after treatment in lieu of three follow-up Pap smears is an option).

Code 87621 may be billed with modifier -26, -TC or –ZS and is reimbursable once every 12 months, any provider, for female recipients 15 years of age or older when billed with one of the following ICD-9 codes:

New Codes

Non-Benefit Codes 87620 and 87622

HPV test codes 87620 (infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, direct probe technique) and 87622 (…papillomavirus, human, quantification) will be non-benefits, effective for dates of service on or after November 1, 2005.