Pathology/Lab Coding Alert

Answer: Lab testing for human papilloma virus (HPV) falls into two different types. The first type is a nucleic acid test to identify the presence or absence of any target nucleotides indicating infection with high-risk types of HPV. The test result will be positive or negative for high-risk HPV but won’t identify which high-risk type(s) are involved.

You might use one of the following codes for this type of test:

• 87624 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68))
• G0476 (Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test). Medicare requires this code, but the HPV test is covered only in addition to a pap test.

For a test that provides more specific genotyping to identify the presence of individual high-risk types, you might report one of the following codes:

• 87625 (… Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed)
• 0500T (Infectious agent detection by nucleic acid (DNA or RNA), Human Papillomavirus (HPV) for five or more separately reported high-risk HPV types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) (ie, genotyping))

Because infection with type 16 and possibly 18 and 45 are associated with a higher risk of cervical cancer, positive results for these type(s) may impact appropriate follow-up testing or procedures.

Look ahead: The CPT^® Editorial Panel May 2024 meeting indicates that coding changes are coming for reporting high-risk HPV testing. If the updates are implemented, you can expect a new code, a revision of 87264, and deletion of 0500T.