Oral Cancer Screening and Testing
Defines coverage criteria and limitations for tests related to oral and oropharyngeal cancer screening and diagnostic testing, including HPV tumor status testing and exclusion of various salivary/genetic biomarker tests and panels. Also lists applicable procedure codes and references to guidelines and regulatory considerations.
No material clinical or coverage changes identified in this brief.
Coverage Summary
This policy addresses testing related to oral and oropharyngeal cancer with a focus on establishing HPV tumor status for individuals with oropharyngeal squamous cell carcinoma. Coverage is mixed: testing for high-risk HPV tumor status by either HPV E6/E7 mRNA expression or p16 immunohistochemistry (IHC) meets coverage criteria, while multiple salivary- or genomic-based adjunctive assays and certain panels do not meet coverage due to insufficient evidence. Guideline concordance is noted: NCCN, CAP, and ASCO accept p16 IHC as a surrogate for HPV status and recognize HPV E6/E7 mRNA as the gold standard; USPSTF guidance states there is insufficient evidence to recommend screening for oral cancer in asymptomatic adults and does not recommend screening for oral HPV infection.
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