Pathology/Lab Coding Alert

Question: I’ve heard that Medicare has started to cover screening tests for HPV. Is that true, and what are the conditions for coverage? 

Michigan Subscriber

Answer: In addition to Pap testing for cervical cancer, Medicare is proposing to begin covering human papillomavirus (HPV) testing once every five for asymptomatic female beneficiaries aged 30-65.

Remember: CPT® 2015 created three new HPV testing codes that your lab might perform:

• 87623 — Infectious agent detection by nucleic acid (DNA or RNA); 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.

CMS recently issued a proposed coverage decision memo spelling out the evidence supporting expanded coverage. Currently, the Medicare program covers a screening pelvic examination and Pap test for female beneficiaries at one- or two-year intervals, based on individual risk factors. The agency says to expect the final coverage decision in July.

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