CurrentAnthemPolicy N/A

Cervical Cancer Screening Age PDF

Notification of Anthem Blue Cross clinical guideline for Medi-Cal Managed Care members: cervical cancer screening is medically necessary for chronically immunosuppressed women under 21 but not medically necessary and will not be reimbursed for average-risk women under 21. Refers to CG-Med-53 for full guideline.

Policy Summary

PayerAnthem

PolicyCervical Cancer Screening Age PDF

Policy CodePolicy N/A

Change TypeClarified coverage for <21 (immunosuppressed vs average-risk)

Effective DateUnspecified

Next Review DateUnspecified

Key ActionEffective with service dates on or after the unspecified effective date, cervical cancer screening procedures and testing will not be reimbursed as a covered benefit for average-risk women younger than age 21.

SourceLink

POLICY UPDATE CHANGES

Anthem notifies providers that cervical cancer screening is medically necessary for chronically immunosuppressed women under 21 and not medically necessary for average-risk women under 21.

1Covered Indication (under 21 - immunosuppressed)

1Not Covered Indication (under 21 - average risk)

Coverage Summary

Notification of Anthem Blue Cross clinical guideline for Medi-Cal Managed Care members: cervical cancer screening is medically necessary for chronically immunosuppressed women under 21 but not medically necessary and will not be reimbursed for average-risk women under 21. Refers to CG-Med-53 for full guideline.

Medical-Necessity Criteria

Medically Necessary Indications

Cervical cancer screening is considered medically necessary when ALL of the following apply:

Patient is female younger than age 21
Patient is chronically immunosuppressed (for example, organ transplant recipient or HIV-seropositive)
Examples include organ transplant recipients or persons seropositive for human immunodeficiency virus (HIV).

Not Medically Necessary / Not Covered

Cervical cancer screening is considered not medically necessary for average-risk women younger than age 21 (and will not be reimbursed) unless the medically necessary criteria above are met:

Patient is female younger than age 21
Patient is average risk (i.e., not chronically immunosuppressed)
Not chronically immunosuppressed and without other listed indications for early screening.

Provider Actions / Billing Impact

Billing Rule

Denial of reimbursement for average-risk women <21

Effective with service dates on or after [date], cervical cancer screening procedures and testing will not be reimbursed as a covered benefit for average-risk women younger than age 21.

Documentation Required

Document immunosuppression status

Providers must document chronic immunosuppression to support medical necessity for cervical cancer screening in women younger than age 21.

Document organ transplant status or HIV seropositivity.

Note

Refer to Anthem guideline CG-Med-53

Providers should access CG-Med-53 on the Anthem Medical Policies and Clinical UM Guidelines search page for the full guideline details.

Background and Evidence

Anthem aligns its reimbursement stance with major clinical bodies: the American Cancer Society, the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Society for Clinical Pathology (ASCP), and the American College of Obstetricians and Gynecologists (ACOG) recommend against screening women younger than age 21 or state screening should begin at age 21.

The United States Preventive Services Task Force (USPSTF) gives screening of women younger than 21 a D rating, indicating the service is recommended against because harms outweigh benefits or there is no net benefit.

Anthem’s policy aligns with these recommendations except it allows cervical cancer screening for an exception: chronically immunosuppressed patients younger than age 21 (for example, organ transplant recipients or persons seropositive for HIV).

Source	Recommendation
American Cancer Society / ASCCP / ASCP	Recommend against cervical cancer screening in women younger than age 21
ACOG (American College of Obstetricians and Gynecologists)	Begin screening at age 21; do not screen women under 21
USPSTF rating	D (recommend against screening women younger than 21)

Chronically immunosuppressed: Examples include organ transplant recipients or persons seropositive for human immunodeficiency virus (HIV).

Average-risk: Not chronically immunosuppressed and without other listed indications for early screening.

Revision History

clarifiedLatest

Anthem clarified coverage: cervical cancer screening is medically necessary for chronically immunosuppressed women younger than age 21 (examples: organ transplant recipients or HIV-seropositive) and is not medically necessary for average-risk women younger than age 21. Effective date for non-reimbursement for average-risk women younger than 21 is unspecified in the notice; the guideline CG-Med-53 is referenced for details.

clarifiedLatest

Anthem states that effective with service dates on or after the unspecified date, cervical cancer screening procedures and testing will not be reimbursed as a covered benefit for average-risk women younger than age 21 and directs providers to access CG-Med-53 on the Anthem Medical Policies and Clinical UM Guidelines search page.

clarifiedLatest

Anthem directs providers to document chronic immunosuppression (for example, organ transplant status or HIV seropositivity) to support medical necessity for screening in women younger than age 21.

Policy Summary

PayerAnthem

PolicyCervical Cancer Screening Age PDF

Policy CodePolicy N/A

Change TypeClarified coverage for <21 (immunosuppressed vs average-risk)

Effective DateUnspecified

Next Review DateUnspecified

SourceLink

On This Page

OpenPayer

Cervical Cancer Screening Age PDF

Coverage Summary

Medical-Necessity Criteria

Provider Actions / Billing Impact

Coding

Background and Evidence

Revision History