CurrentBlue Cross Blue Shield - IllinoisPolicy CPCPLABOO2

Cervical Cancer Screening

Reimbursement criteria for cervical cancer screening tests (Pap, high-risk HPV, and co-testing) describing when services are eligible for payment under BCBSIL lab management; applies to providers billing Blue Cross Blue Shield Illinois members.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLABOO2

Change TypeNew policy

Effective DateSep 25, 2025

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code sets; additional documentation may be requested.

SourceLink

POLICY UPDATE CHANGES

New policy establishing reimbursement criteria for cervical cancer screening methods and patient groups.

21-29age range: Pap smear every 3 years

30-65age range: hr-HPV alone every 5y or Pap 3y or co-testing

3/5recommended screening intervals (30-65)

65+routine screening not reimbursable (over)

under21not reimbursable

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Cervical Cancer Screening Coverage Criteria

Cervical cancer screening coverage criteria

Reimbursement is provided only under the specified test types, intervals, and patient risk groups below.

Individuals 21–29 years of age: reimbursable once every 3 years using conventional or liquid‑based Papanicolaou (Pap) smear; applicable to individuals with a cervix.

Individuals 30–65 years of age

High‑risk HPV (hr‑HPV) testing alone once every 5 years may be reimbursable.
Conventional or liquid‑based Pap smear once every 3 years may be reimbursable.
Co‑testing (cytology with concurrent hr‑HPV testing) once every 5 years may be reimbursable.

Individuals <21 years of age: Routine cervical cytology and HPV testing are not reimbursable.

Individuals >65 years of age

If immunocompromised, immunosuppressed, or otherwise high‑risk (history of high‑grade precancerous lesion or cervical cancer, in‑utero DES exposure, organ transplant, prior abnormal cytology or positive HPV), follow the frequency described for individuals 30–65 (i.e., any of the options in that group may be reimbursable).
If not immunocompromised/immunosuppressed and not high‑risk, routine cervical cancer screening is not reimbursable.

Immunocompromised or immunosuppressed individuals (any age): Any cervical cancer screening technique may be reimbursable, including annual cervical cytology; co‑testing once every 3 years for individuals ≥30 years of age is also described.

Pooled hr‑HPV positive: For individuals who are pooled hr‑HPV positive, nucleic acid testing for high‑risk strains HPV‑16 and HPV‑18 may be reimbursable (i.e., follow‑up genotyping testing).

Exclusions (not reimbursable)

Testing for low‑risk HPV is not reimbursable.
Cervical cancer screening after hysterectomy with removal of the cervix is not reimbursable if there is no history of cervical cancer or precancer.
All other technologies not discussed in these criteria are not reimbursable.

Procedure Codes and Screening Intervals

Procedure codesmixed

No codes listed

Screening intervals (Pap, hr-HPV, co-testing)

Ages 21-29Conventional or liquid-based Pap smear every 3 years

Ages 30-65 — option 1High-risk HPV (hr-HPV) test alone once every 5 years

Ages 30-65 — option 2Conventional or liquid-based Pap smear once every 3 years

Ages 30-65 — option 3Co-testing (cytology + hr-HPV) once every 5 years

Special — immunocompromised/immunosuppressedMay include annual cervical cytology or co-testing once every 3 years (for individuals 30+); any cervical cancer screening technique may be reimbursable

Documentation and Billing Requirements

Documentation Required

Submit accurate documentation and use valid HIPAA‑approved code sets

Providers are responsible for submitting accurate documentation of services performed and must bill using valid HIPAA-approved code sets. Claims should be coded according to industry-standard coding guidelines (for example, UB, AMA CPT, HCPCS, ICD-10-CM/PCS, NCCI/CCI edits) and may be subject to review; BCBSIL may request additional documentation to support the claim.

Submit claims using valid code combinations from HIPAA‑approved code sets.
Code claims according to industry standard coding guidelines (e.g., UB, CPT, HCPCS, ICD‑10, NCCI/CCI).
Be prepared to provide additional documentation upon request for claim review.

Key Definitions

Definition of "individual(s)"

Definition"Individual(s)" refers to individuals with a cervix for the purposes of these reimbursement criteria.

ScopeApplies throughout the policy when describing eligibility for cervical cancer screening reimbursement

Exclusions noteIndividuals post-hysterectomy with removal of cervix and no history of cervical cancer/pre-cancer are not eligible for screening reimbursement

Definition of high-risk

High-risk — immunocompromised/immunosuppressedIncludes individuals who are immunocompromised or immunosuppressed; any cervical cancer screening technique may be reimbursable and may include annual cytology

High-risk — prior disease or exposureIncludes individuals with prior high-grade precancerous lesion or cervical cancer, and individuals with in-utero exposure to diethylstilbestrol (DES)