New Medicare Benefit: HPV Screening
The Centers for Medicare & Medicaid Services (CMS) has added Human Papillomavirus (HPV) testing to the list of Medicare covered preventive services, under specific conditions.
Conditions for Coverage
CMS will cover screening for cervical cancer with HPV testing once every 5 years as a preventive service benefit under Medicare for asymptotic patients age 30 to 65 years old, with a Pap smear.
CMS has created a new code to report this service: Effective July 9, 2015, labs (place of service 81 Independent laboratory or 11 Office) may report HCPCS Level II G0476 HPV combo assay, CA screen.
This code will be priced by Medicare administrative contractors for claims with dates of service between July 9, 2015 to December 31, 2016. Beginning January 1, 2017, G0476 will be priced and paid according to the Clinical Laboratory Fee Schedule. As cervical cancer screening is a preventive service, no coinsurance or deductible applies.
To support medical necessity of G0476, appropriate diagnosis coding is:
For dates of service before October 1, 2015 – ICD-9 V73.81 Special screening examination for human papillomavirus (HPV) [as primary] and V72.31 Routine gynecological examination [as secondary]
For dates of service on or after October 1, 2015 – ICD-10 Z11.51 Encounter for screening for human papillomavirus (HPV) and Z01.411 Encounter for gynecological examination (general)(routine) with abnormal findings or Z01.419 Encounter for gynecological examination (general)(routine) without abnormal findings
Refer to national coverage determination 210.2.1 for complete guidance.
Source: MLN Matters 9434