CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABOOZ

Cervical Cancer Screening

Reimbursement and coverage criteria for cervical cancer screening tests (cytology and high-risk HPV) for Blue Cross Blue Shield - Oklahoma members; applies to providers submitting claims for individuals with a cervix.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLABOOZ

Change TypeMultiple material revisions (genotyping, age-based exclusions, coding updates)

Effective DateSep 26, 2025

Next Review DateN/A

Key ActionSubmit accurate documentation and use valid HIPAA-approved codes when billing cervical cancer screening and HPV testing services.

SourceLink

POLICY UPDATE CHANGES

Reimbursement criterion #5 revised to state: For individuals who are pooled hr-HPV positive, nucleic acid testing for high-risk strains HPV-16 and HPV-18 may be reimbursable.

Reimbursement criterion #8 revised to state routine cervical cancer screening is not reimbursable for individuals over 65 who are not immunocompromised, immunosuppressed, or otherwise high-risk.

Testing for low-risk HPV is not reimbursable.

For cervical cancer screening, all other technologies not discussed in the policy are not reimbursable.

Procedure code 87626 was added and code O500T was removed.

every 3 yrsPap interval 21-29

3–5 yrsOptions 30-65

annualImmunocompromised

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Coverage and Reimbursement Criteria

Covered screening criteria

Covered when the conditions below are met according to age and risk status:

Immunocompromised individuals

Techniques: a) Annual cervical cytology testing for individuals of all ages; b) Co-testing (cervical cytology and high-risk HPV testing) once every 3 years for individuals 30 years of age or older.

Age 21-29: For individuals 21 to 29 years of age, cervical cancer screening once every 3 years using conventional or liquid based Papanicolaou (Pap) smears may be reimbursableage 21-29

Age 30-65

Options: a) Conventional or liquid based Pap smear once every 3 years; b) High-risk HPV test alone once every 5 years; c) Co-testing (cytology with concurrent high-risk HPV testing) once every 5 years.

High-risk over 65: For individuals over 65 years of age who are considered high-risk (history of high-grade precancerous lesion or cervical cancer, in-utero DES exposure), screening at the frequencies described for ages 30-65 may be reimbursableage >65 and high-risk

Reflex genotyping after 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 reimbursablepooled hr-HPV positive

reflex HPV-16/18 genotyping

Younger and other specific indications: For individuals 65 years of age or younger, annual cervical cancer screening by smear or hr-HPV testing may be reimbursable in situations including prior abnormal cytology and/or prior positive HPV, and for those at high risk (e.g., organ transplant, DES exposure)age <=65 with specified conditions

Cervical cancer screening for individuals younger than 21 years of age is generally not reimbursable. Exceptions exist only where other specific criteria in this policy apply (for example, documented history of HIV or other immunocompromising condition, prior diagnosis of cervical cancer or high-grade dysplasia, or other circumstances explicitly noted elsewhere in the reimbursement criteria). Claims for screening in individuals <21 that do not meet an exception are subject to denial.

Providers should document the clinical indication supporting any screening performed on individuals under 21 (e.g., HIV, prior high-grade lesion, prior cervical cancer) and submit that documentation with the claim to demonstrate the applicable exception. Routine screening for this age group without qualifying conditions is excluded from coverage.

Routine cervical cancer screening is not reimbursable for individuals over 65 years of age who are not considered high-risk. High-risk status includes a history of high‑grade precancerous lesion or cervical cancer, documented in‑utero diethylstilbestrol (DES) exposure, or other conditions identified in this policy. For individuals >65 who meet high‑risk criteria, screening at the frequencies described for ages 30–65 may be reimbursable.

When submitting claims for screening in individuals over 65, include documentation supporting high‑risk status when applicable. Absent evidence of high‑risk features or ongoing clinical indications, routine screening claims for members >65 are not eligible for reimbursement.

Procedure and Billing Codes

Codes referenced in policyCPT | HCPCS | mixed

87623
87624
87625
87626
88141
88142
88143
88147
88148
88150

1–10 of 11

1/2

Provider Responsibilities, Billing, and Denial Risk

Documentation Required

Claims documentation and coding

Providers must submit accurate, complete documentation and use HIPAA‑approved code sets when billing for cervical cancer screening services. Claims are subject to code‑edit protocols and clinical review; upon request, submit additional supporting documentation to avoid denials.

Submit claims using valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, DRG).
Claims are reviewed against benefit terms, provider contracts, medical policies, clinical payment and coding policies, and automated code‑edit software.
Provide additional documentation promptly when requested to support medical necessity.

Billing Rule

Procedure codes referenced (billing alert)

Clinical and Guideline Background

This reimbursement policy aligns coverage criteria for cervical cancer screening with major guideline bodies and clinical practice by specifying age-based intervals and separate rules for immunocompromised or otherwise high‑risk individuals. It defines covered techniques (cytology, high‑risk HPV testing, and co‑testing) and operationalizes reflex nucleic acid genotyping for HPV‑16 and HPV‑18 when pooled high‑risk HPV testing is positive.

The policy rationale balances evidence-based screening intervals (e.g., Pap every 3 years for ages 21–29; Pap, hr‑HPV alone, or co‑testing options for ages 30–65 with defined intervals) with exclusions intended to avoid low‑value or unnecessary testing — for example, routine screening under age 21 and routine screening over 65 in average‑risk individuals are not reimbursable. The policy also excludes testing for low‑risk HPV and any technologies not explicitly discussed.

Key Definitions

Definition — "individual(s)"

Definition"Individual(s)" refers specifically to individuals with a cervix.

ScopeApplies throughout this policy to all references to "individual(s)" in coverage and reimbursement criteria.

ContextUsed to align policy language with guideline-referenced recommendations for cervical cancer screening.

Related termsDoes not imply sex, gender identity, or other characteristics beyond having a cervix.