ModifiedAnthemPolicy N/A

Cervical Cancer Screening Frequency PDF

Defines reimbursement policy and recommended screening intervals for routine cervical cancer screening in average-risk women, excluding women with prior abnormal results, pre-cancerous lesions, cervical cancer, or immunocompromised status. Specifies age-based coverage and frequency limits.

Policy Summary

PayerAnthem

PolicyCervical Cancer Screening Frequency PDF

Policy CodePolicy N/A

Change TypeFrequency and age-based coverage limits

Effective Date[insert date 90 days from alert mailing]

Next Review Date

Key ActionDo not bill for routine screening Pap testing for women age 21-65 more frequently than once every three years; routine Pap testing for women younger than 21 will not be reimbursed and for women 66+ with prior negative screening will be denied.

SourceLink

POLICY UPDATE CHANGES

Routine screening frequency for women age 21 to 65 will be reimbursed no more frequently than once every three years.

Routine screening pap testing will not be reimbursed for women younger than 21 years of age.

Reimbursement for routine pap testing for women 66 and older with prior negative screening results will be denied.

Age <21Routine screening reimbursed

21-29Pap every 3 years

30-65Co-test every 5 yrs or Pap every 3 yrs

66+Routine screening denied if prior negative

Coverage Summary

This policy defines reimbursement and recommended screening intervals for routine cervical cancer screening in average-risk women (those without prior abnormal results, pre-cancerous cervical lesions, cervical cancer, or immunocompromised status). It specifies age-based coverage and frequency limits for routine screening.

The purpose is to align reimbursement with major medical society guidelines and to set age-based frequency limits for routine Pap and HPV testing for average-risk women.

Routine screening thresholds and age-based summary

Threshold (age 21-65)Routine screening reimbursed no more frequently than once every three years for cervical Pap testing; when co-testing with HPV, interval is every five years

Age <21Routine screening Pap testing will not be reimbursed

Age 21-29Recommended: cervical Pap alone every 3 years (reimbursed no more frequently than every 3 years)

Age 30-65Recommended: HPV + Pap co-testing every 5 years OR Pap alone every 3 years

Age 66+Routine Pap testing denied for women 66 and older with prior negative screening results

Age- and Context-Based Coverage Criteria

Coverage by age and clinical context

Routine cervical cancer screening reimbursement and recommended intervals for average-risk women:

ALL of the following

Women younger than 21 years
- Routine screening pap testing will not be reimbursed for women younger than 21 years of age.
Women age 21-29 years
- Routine screening reimbursed no more frequently than once every three years.
Women age 30-65 years
- Routine screening reimbursed with specified intervals: HPV and cervical pap co-testing every five years OR cervical pap alone every three years.

Not Covered / Denied Scenarios

Routine screening Pap testing will not be reimbursed for women younger than 21 years.

Routine screening for women age 21 to 65 will be reimbursed no more frequently than once every three years (with co-testing interval guidance described elsewhere).

Reimbursement for routine Pap testing for women 66 years and older with adequate prior negative screening results will be denied.

These routine screening frequency limits do not apply to women with prior abnormal results, pre-cancerous lesions, cervical cancer, or immunocompromised status (see exclusions/documentation requirements).

Coding

No specific CPT/HCPCS codes listedmixed

No codes listed

Actions for Providers

Billing Rule

Frequency limitation for routine Pap testing

Do not bill for routine screening Pap testing for women age 21-65 more frequently than once every three years; routine Pap testing for women younger than 21 will not be reimbursed and for women 66 and older with prior negative screening results will be denied.

Documentation Required

Exclude higher-risk clinical contexts

Do not apply the routine screening frequency limits to women with higher-risk clinical contexts; documentation must support the exclusion from average-risk routine screening rules if billing more frequently.

History of prior abnormal results
Pre-cancerous cervical lesions
Cervical cancer
Immunocompromised status

Background and Guideline Alignment

Anthem is aligning reimbursement with USPSTF, ACOG, and ACS/ASCCP/ASCP guidelines and encourages adoption of these recommendations to improve patient quality and reduce harm from unnecessary follow-up. The guidance supports less frequent screening intervals for average-risk women to avoid unnecessary procedures and downstream harms.

Guideline sources: USPSTF (2012); ACOG Practice Bulletin 157 (2016); Saslow et al., ACS/ASCCP/ASCP guidelines (2012).

Revision History

[insert date 90 days from alert mailing]policy_change_addedLatest

Routine screening frequency for women age 21 to 65 will be reimbursed no more frequently than once every three years. (This is effective [insert date 90 days from alert mailing] per the alert.)

policy_change_addedLatest

Routine screening Pap testing will not be reimbursed for women younger than 21 years of age.

policy_change_added