Ensure correct coding for cervical cancer screenings with HPV testing
The American Cancer Society estimates that nearly 13,500 patients in the U.S. will be diagnosed with invasive cervical cancer in 2026, and approximately 4,200 will die from the disease. Although cervical cancer was once one of the leading causes of cancer death among women, mortality has declined by more than 50% in the past few decades, largely due to increased utilization of screening and human papillomavirus (HPV) testing.
Since 2015, Part B has covered HPV testing as a preventive service when performed in conjunction with cervical cancer screening for asymptomatic female patients aged 30–65. Part B covers a Pap test for most female beneficiaries once every 12–24 months, depending on certain risk factors. However, Medicare only covers an HPV test once every five years for those who meet criteria, and it must be performed with a Pap test. CMS will deny an HPV test if it is conducted within five years of the previous test.
Pap tests and HPV screenings are paid under the Clinical Laboratory Fee Schedule. For HPV testing, organizations should report Healthcare Common Procedure Coding System (HCPCS) code G0476 (infectious agent detection by nucleic acid [DNA or RNA]; HPV, high-risk types for cervical cancer screening). As these services are required to be performed in the same encounter, facilities should report the applicable HCPCS procedure codes as separate claim line items.
Along with the appropriate HCPCS codes, each claim must contain the HPV ICD-10-CM screening diagnosis codes. Z11.51 (encounter for screening for HPV) must be reported on all claims, as well as one of the following secondary diagnosis codes, as appropriate:
- Z01.411: Encounter for gynecological examination (general) (routine) with abnormal findings
- Z01.419: Encounter for gynecological examination (general) (routine) without abnormal findings
Revenue integrity professionals can review NCD 210.2.1 for more information on Part B coverage of cervical cancer screenings with HPV testing. Additional coding and billing guidance on these services can be found here.