CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB002

Cervical Cancer Screening

Defines reimbursement and coding criteria for cervical cancer screening tests (Pap and HPV) for Blue Cross Blue Shield of New Mexico members; applies to providers submitting claims for these services.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLAB002

Change TypeMaterial code additions and literature updates

Effective DateNov 19, 2024

Next Review Date

Key ActionReview product-specific plan documents for coverage and prior authorization requirements before submitting claims.

SourceLink

POLICY UPDATE CHANGES

Added new CPT code 87626 effective 01/01/2025.

Added code 0502U.

Reimbursement information unchanged but literature review and references were updated.

~27procedure and lab codes listed

Annualscreening may be reimbursable starting at age 18

q3yHPV testing interval for individuals aged 30+

Not reimbursablepost-hysterectomy screening

Not reimbursable

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low-risk HPV strains in co-testing

Coverage Criteria

Covered screening indications

Reimbursement criteria (based on listed professional guidance):

Age-based and risk-based screening: Annual cervical cancer screening may be reimbursable for individuals 18 years of age and older; and for individuals who are at risk for cancer or at risk of other health conditions that can be identified through cytologic screening.age >=18 or at-risk

Applies to individuals with a cervix.

HPV testing frequency for older individuals: HPV testing may be reimbursable once every three (3) years for individuals aged 30 and older.age >=30 and interval >=3 years

Exclusions — post‑surgical and test content

For individuals who have undergone surgical removal of the uterus and cervix and who have no history of cervical cancer or pre‑cancer, cervical cancer screening (at any age) is not reimbursable.
The following are not reimbursable: a) inclusion of low‑risk strains of HPV in co‑testing; b) other technologies for cervical cancer screening.

Cervical cancer screening is not reimbursable for individuals who have undergone surgical removal of the uterus and cervix and who have no history of cervical cancer or precancer. Claims for screening in this situation may be denied.

The policy specifies that the inclusion of low-risk strains of HPV in co-testing is not reimbursable and such claims may be denied.

Screening tests that include low-risk HPV strains in co-testing or that use other technologies for cervical cancer screening identified by the policy are not reimbursable.

Procedure and Coding

Procedure and lab codes listed in policymixed

87623
87624
87625
87626
88141
88142
88143
88147
88148
88150

1–10 of 32

1/4

inv-06: HPV testing interval — once every three (3) years for individuals aged 30 and older

HPV testing intervalHPV testing may be reimbursable once every three (3) years for individuals aged 30 and older.

ApplicabilityApplies to individuals with a cervix as defined in the reimbursement criteria.

Related guidanceCriteria based on USPSTF, NCI, NCCN, ASCCP, ACS, ASCP, and ACOG recommendations.

Provider Actions and Billing Notes

Note

Plan-specific coverage — review plan documents

Reimbursement follows the terms of the member's plan. If there is a conflict between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. If a conflict arises between this policy and any provider contract, the provider contract will govern. "Plan documents" include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. Blue Cross and Blue Shield of New Mexico may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case; BCBSNM has final discretionary authority to interpret and apply this policy to the extent provided under any applicable plan documents. Providers are urged to review product plan documents for eligible coverage for services rendered.

Plan-specific coverage governs over this policy when conflicts exist; review member plan documents (Certificates, benefit booklets, Summary Plan Descriptions).
BCBSNM may exercise discretion in applying this policy; provider contracts govern when in conflict.

Documentation Required

Claims documentation and coding

Background and Evidence Basis

This policy bases reimbursement criteria on recommendations from the U.S. Preventive Services Task Force, the National Cancer Institute, NCCN, the American Society for Colposcopy and Cervical Pathology, the American Cancer Society, the American Society for Clinical Pathology, and the American College of Obstetricians and Gynecologists. Within these reimbursement criteria, the term 'individual(s)' is used specifically to refer to individuals with a cervix.

Definitions

inv-13: Persons with a cervix (term used throughout reimbursement information) — 'individual(s)' term clarification

Defined termWithin these reimbursement criteria, 'individual(s)' is specific to individuals with a cervix.

Scope'Individual(s)' is used throughout reimbursement information to indicate people who have a cervix.

Implication for claimsCoverage determinations and coding intervals (e.g., annual screening, q3y HPV testing) apply to individuals with a cervix.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLAB002

Change TypeMaterial code additions and literature updates

Effective DateNov 19, 2024

Next Review Date

Key ActionReview product-specific plan documents for coverage and prior authorization requirements before submitting claims.

SourceLink

On This Page

Providers must submit accurate documentation and use valid HIPAA‑approved code sets when filing claims. Claims are subject to code edit protocols and may be reviewed for adherence to benefit coverage, provider contract language, medical policies, and coding policy rules. Upon request, providers should submit additional documentation to support the claim.

Use industry-standard code sets and guidelines (e.g., Uniform Billing, AMA CPT, HCPCS, ICD-10-CM/PCS, NDCs, DRG, CMS NCCI edits).
Claims may be adjusted or denied if coding or documentation is incomplete or inconsistent.

Denial Risk

Post‑hysterectomy screening — not reimbursable

For individuals who have undergone surgical removal of the uterus and cervix (hysterectomy with removal of the cervix) and who have no history of cervical cancer or precancer, cervical cancer screening at any age is not reimbursable. Verify patient surgical and cancer history before submitting claims for cervical cancer screening in post‑hysterectomy patients.

Do not bill cervical cancer screening for individuals post‑hysterectomy with no history of cervical cancer or precancer.
If history of cervical cancer or precancer exists, document appropriately and submit supporting records when requesting reimbursement.

Denial Risk

Non‑reimbursable test content and technologies

Claims that include testing for low‑risk HPV strains as part of co‑testing, or that utilize other non‑reimbursable cervical cancer screening technologies, may be denied. Ensure testing panels and technologies billed are limited to reimbursable components and supported by the applicable policy criteria.

Inclusion of low‑risk HPV strains in co‑testing is not reimbursable.
Other non‑specified screening technologies for cervical cancer are not reimbursable; verify that the method billed is an accepted reimbursable test.
Refer to CPCPLAB51 for additional HPV testing guidance and to plan documents for product‑specific coverage.