Clinical Context
A typical patient is a cisgender woman or other person with a cervix presenting for cervical cancer screening or follow-up of an abnormal screening result. A 35-year-old patient attends a primary care or gynecology visit for routine cervical cancer screening. The clinician collects a liquid-based cervical specimen during a pelvic exam and sends it to the clinical laboratory. The laboratory performs nucleic acid amplification testing for high-risk human papillomavirus (HPV) types using an FDA-cleared assay that reports pooled high-risk results and may also separately identify specific high-risk subtypes (for example HPV-16, HPV-18).
The clinical workflow includes specimen accessioning, nucleic acid extraction, amplification and detection, result validation by the laboratory analyst, and transmission of results to the ordering provider. Results guide clinical management: negative high-risk HPV supports routine surveillance; positive high-risk HPV triggers guideline-based follow-up such as reflex cytology, repeat testing, or colposcopy depending on age, cytology result, and subtype identified.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | When billing only the professional interpretation component performed by a qualified laboratory physician or pathologist |
90 | Reference laboratory performing service | When the testing was performed by an outside reference laboratory
TC | Technical component | When billing only the technical component (laboratory processing) of the test
91 | Repeat clinical diagnostic laboratory test performed on the same day | When the test is repeated on the same specimen or patient same day for reliability or quality control
59 | Distinct procedural service | When two separate services are performed at the same encounter that are not typically bundled
QK | Clinical laboratory improvement amendment (CLIA) waived test performed in a non-laboratory setting | When performed in a CLIA-waived POC setting if applicable
QX | Qualified nonphysician practitioner performed service | When a certified nonphysician performs the testing service under supervising provider
QY | Medical direction of two, three, or four ancillary personnel | When physician directs multiple laboratory personnel for the service
52 | Reduced services | When a test is partially reduced or not fully completed
53 | Discontinued procedure | When testing was started but discontinued for documented reasons
59 | Distinct procedural service | When reporting a separate service that is not usually reported with the lab test
62 | Two surgeons | Rarely applicable; use if two qualified providers share responsibility for a complex diagnostic procedure
90 | Reference laboratory performing service | When an external lab performs the assay and the ordering entity bills
| Taxonomy Code | Specialty | Notes |
|---|
207Q00000X | Obstetrics & Gynecology | Common ordering specialty for cervical HPV testing |
207L00000X | Family Medicine | Primary care clinicians frequently order screening HPV tests
208D00000X | Internal Medicine | Internal medicine physicians order HPV testing in adult patients
173P00000X | Pathology & Laboratory Medicine | Laboratory physicians oversee test validation and interpretation
330600000X | Clinical Laboratory | Clinical laboratory personnel perform the assay and analytic processes
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
Z11.51 | Encounter for screening for human papillomavirus (HPV) | Primary screening indication for high-risk HPV testing |
R87.610 | Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US) | Reflex HPV testing is commonly performed when cytology shows ASC-US
N87.9 | Dysplasia of cervix uteri, unspecified | Positive high-risk HPV may explain cervical dysplasia and guide colposcopy
N86 | Erosion and ectropion of cervix uteri | Abnormal cervical findings prompting combined cytology and HPV testing
Z12.4 | Encounter for screening for malignant neoplasm of cervix | HPV testing is part of cervical cancer screening protocols
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
87624 | Infectious agent detection by nucleic acid (DNA or RNA); Human papillomavirus (HPV), low-risk types, direct probe technique | May be ordered when specific low-risk HPV detection is clinically indicated or for broader HPV typing panels |
87625 | Infectious agent detection by nucleic acid (DNA or RNA); Human papillomavirus (HPV), high-risk types, direct probe technique | Alternative high-risk HPV detection method; may be used by some labs depending on assay platform
87627 | Infectious agent detection by nucleic acid (DNA or RNA); Human papillomavirus (HPV), types 16 and 18, direct probe technique | Used when specific reporting of HPV-16 and HPV-18 is required in addition to pooled high-risk results
88142 | Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician | Reflex or concurrent cytology may be performed when HPV testing is positive or per screening protocols
88175 | Cytopathology, cervical or vaginal, slides, automated screening/rapid review | May be used for automated cytology screening in the workflow accompanying HPV testing