Ob-Gyn Coding Alert

Here’s when the coverage decision will be made.

Medicare is proposing to begin covering human papillomavirus testing once every 5 years in conjunction with the Pap smear test for its asymptomatic female beneficiaries aged 30-65 years old in an effort to better detect cervical cancer.

Remember:  CPT® 2015 created three new HPV testing codes that your ob-gyn may order:

• 87623 — … Human Papillomavirus (HPV), low-risk types (e.g., 6, 11, 42, 43, 44)

• 87624 — … Human Papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)

• 87625 — … Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed.

The Centers for Medicare & Medicaid Services issued a proposed coverage decision memo on April 16 spelling out the evidence supporting expanded coverage. Currently, the Medicare program covers a screening pelvic examination and Pap test for female beneficiaries at 1- or 2-year intervals, based on individual risk factors.

CMS began considering HPV test coverage at the request of the American Academy of Family Physicians.

In 2012, the U.S. Preventive Services Task Force gave the evidence for this screening approach – Pap test plus HPV testing every 5 years for women aged 30-65 years – a grade A. HPV testing for women aged 30 years and older is already a covered preventive benefit under the Affordable Care Act. CMS officials are taking comments on the proposed coverage decision; a final coverage decision in expected in July. 

Heads up: See the proposed coverage decision at: http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=278