Effective for dates of service on or after December 1, 2018, CPT code 87625 (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], types 16 and 18 only, includes type 45, if performed) is a new Family Planning, Access, Care and Treatment (Family PACT) Program benefit. CPT code 87625 is reimbursable with modifier 33 for female clients 30 to 65 years of age for the management of a positive primary high-risk human papillomavirus (hrHPV) result. Use of modifier 33 indicates the service was provided in accordance with a U.S. Preventive Services Task Force (USPSTF) A or B recommendation. The service must be billed with the ICD-10-CM diagnosis code that identifies the contraceptive method for which the client is being seen. Additional ICD-10-CM diagnosis code R87.810 (cervical high-risk human papillomavirus [HPV] DNA test positive) is required.
An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.