CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABOOZ

Cervical Cancer Screening

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Reimbursement criteria and coding guidance for cervical cancer screening tests for individuals with a cervix, including age- and risk-based frequency and allowable test types; applies to Blue Cross and Blue Shield of Texas plans and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLABOOZ

Change TypeMaterial revisions and additions

Effective DateSep 26, 2025

Last ReviewSep 26, 2025

Next Review Date

Key ActionSubmit accurate documentation and appropriate HIPAA-approved coding when requesting reimbursement for cervical cancer screening services; additional documentation may be requested during claim review.

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.

Added: Testing for low-risk HPV is not reimbursable.

Added: For cervical cancer screening, all other technologies not discussed above are not reimbursable.

Removed code O500T from the procedure code list.

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CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABOOZ

Cervical Cancer Screening

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Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLABOOZ

Change TypeMaterial revisions and additions

Effective DateSep 26, 2025

Last ReviewSep 26, 2025

Next Review Date

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.

Added: Testing for low-risk HPV is not reimbursable.

Added: For cervical cancer screening, all other technologies not discussed above are not reimbursable.

Removed code O500T from the procedure code list.

Coverage by Age, Risk, and Test Type

Coverage by age and risk

Covered when applicable to the individual's age and risk status as specified below:

Immunocompromised individuals: For immunocompromised or immunosuppressed individuals, any one of the following may be reimbursable: annual cervical cytology for individuals of all ages; or co-testing (cervical cytology + high-risk HPV testing) once every 3 years for individuals >=30 years.

Reimbursement criterion 1

Individuals 21-29: Cervical cancer screening once every 3 years using conventional or liquid-based Papanicolaou (Pap) smears may be reimbursable.21-29 years

Reimbursement criterion 2

Individuals 30-65: Any one of the following may be reimbursable: high-risk HPV (hr-HPV) testing alone once every 5 years; conventional or liquid-based Pap smear once every 3 years; or co-testing (cytology with concurrent hr-HPV testing) once every 5 years.30-65 years

Reimbursement criterion 3

Individuals >65 who are high-risk: Individuals over 65 who are considered high-risk (history of high-grade precancerous lesion or cervical cancer, or in-utero DES exposure) may be screened at the frequencies described for individuals 30-65.>65 and high-risk

Reimbursement criterion 4

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.

Reimbursement criterion 5

Younger than 21: Cervical cancer screening (cervical cytology, HPV testing) for individuals <21 years of age is not reimbursable except as addressed above.<21 years

Reimbursement criterion 7

Individuals >65 not high-risk: For individuals over 65 who are not immunocompromised, immunosuppressed, or otherwise considered high-risk (no abnormal cytology or prior hr-HPV positive), routine cervical cancer screening is not reimbursable.>65 years

Reimbursement criterion 8

Testing for low-risk HPV is not reimbursable. The policy explicitly states that testing for low-risk HPV is excluded from reimbursement. Additionally, cervical cancer screening (including cytology and HPV testing) for individuals younger than 21 years is not reimbursable except where specific exceptions described elsewhere in the policy apply (for example, certain high-risk situations).

Routine cervical cancer screening is not reimbursable for individuals aged over 65 years who are not immunocompromised, immunosuppressed, or otherwise considered high-risk (for example, no history of abnormal cytology or prior hr-HPV positivity). Immunocompromised or immunosuppressed individuals are treated as a separate category with different allowable screening frequencies and are therefore exempt from this discontinuation rule.

Procedure Codes and Screening Intervals

Codes listed in policyCPT|HCPCS|mixed

87623
87624
87625
87626
88141
88142
88143
88147
88148
88150

1–10 of 11

1/2

Age-based screening intervals

Age 21-29Cervical cancer screening once every 3 years using conventional or liquid‑based Papanicolaou (Pap) smears may be reimbursable.

Age 30-65Any one of: hr‑HPV testing alone once every 5 years; conventional or liquid‑based Pap smear once every 3 years; or co‑testing (cytology + hr‑HPV) once every 5 years may be reimbursable.

Immunocompromised individualsFor immunocompromised or immunosuppressed individuals, reimbursable options include annual cervical cytology for individuals of all ages or co‑testing once every 3 years for individuals ≥30 years.

Billing, Documentation, and Denial Risk

Prior Authorization

Prior Authorization / Code Note

Prior authorization is not specified in this policy text. Providers should verify member-specific plan documents and product-specific lab management rules for any prior authorization requirements before performing services.

Check member's plan documents and product-specific lab management rules for prior authorization requirements.
In absence of an explicit prior authorization rule here, follow the governing plan document or provider contract.

Documentation Required

Provider Action — Documentation & Coding

Providers must ensure coding and claims submissions are accurate and complete. Submit all supporting clinical documentation upon request to support medical necessity and correct code combinations.

Use HIPAA-approved code sets (CPT, HCPCS, ICD-10, NDC, DRG) and follow AMA, CMS, and NCCI guidance.

Evidence Sources and Guideline Alignment

This policy aligns screening recommendations with major national guideline sources including the U.S. Preventive Services Task Force, the American Cancer Society, the National Cancer Institute, ACOG, and ASCCP. The reimbursement approach is age- and risk-based: screening frequency and allowable test modalities (cytology, high-risk HPV testing, co-testing, and reflex genotyping for HPV-16/18 when pooled hr-HPV positive) are determined by an individual’s age group and clinical risk status, and exclusions are applied for specified low-value tests and scenarios.

Key Definitions

Definition

ApplicabilityAll coverage, exclusion, and frequency statements in this policy apply to individuals with a cervix unless stated otherwise.

Documentation implicationProviders should consider patient anatomy (presence of a cervix) when applying reimbursement criteria for cervical cancer screening.