CurrentBlue Cross Blue Shield - TexasPolicy CPCPLAB002

Cervical Cancer Screening

Reimbursement and coverage criteria for cervical cancer screening tests (Pap cytology, high-risk HPV testing, and co-testing) for individuals with a cervix across applicable Blue Cross Blue Shield - Texas products.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLAB002

Change TypeMaterial clinical updates

Effective DateMay 15, 2025

Next Review DateN/A

Key ActionSubmit claims with accurate documentation and use listed procedure codes; codes are subject to reimbursement criteria and claim review.

SourceLink

POLICY UPDATE CHANGES

Added immunocompromised to reimbursement criterion #1.

Revised criterion 1a to include individuals of all ages (was individuals less than 30 years of age).

Revised criterion 1b to state high-risk HPV testing.

Removed 'or individuals who are immunocompromised' from criterion 4.

Added the word 'nucleic acid' to criterion 5 regarding HPV-16 and HPV-18 testing.

Added 'For individuals 65 years of age or younger' to criterion 6 and removed 'immunocompromised individuals' from 6b.

Added code 87626 to the procedure codes list.

30+procedure and screening codes included

Age-basedscreening interval rules

Annual

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLAB002

Change TypeMaterial clinical updates

Effective DateMay 15, 2025

Next Review DateN/A

Key ActionSubmit claims with accurate documentation and use listed procedure codes; codes are subject to reimbursement criteria and claim review.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria for Cervical Cancer Screening

Main reimbursement criteria

Covered when ALL of the following are met for the specified group (age/risk specific):

Immunocompromised or immunosuppressed individuals

Options
- Annual cytology: Annual cervical cytology testing for individuals of all ages is reimbursable.
- Co-testing (cervical cytology and high-risk HPV testing) once every 3 years for individuals 30 years of age or older is reimbursable.

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

Individuals 30-65 years: Any one of the following is reimbursable: (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.

Individuals over 65 at high risk: For individuals over 65 who are considered high-risk (history of high-grade precancerous lesion or cervical cancer, in-utero DES exposure), cervical cancer screening at the frequency described for 30-65 years may be reimbursable.

HPV positive / cytology negative individuals: Nucleic acid testing for high-risk strains HPV-16 and HPV-18 may be reimbursable.

Annual screening exceptions (for individuals 65 or younger): For individuals 65 years of age or younger, annual cervical cancer screening by Pap smear or HPV testing may be reimbursable in the following situations: (a) previous abnormal cytology and/or positive HPV; (b) high risk for cervical cancer (organ transplant, DES exposure).

The policy explicitly excludes certain tests and approaches from reimbursement. Inclusion of low-risk strains of HPV in co-testing is not reimbursable. Additionally, the policy states that other technologies for cervical cancer screening (unspecified or nonstandard methods beyond cytology and high-risk HPV testing) are not reimbursable.

Routine cervical cancer screening is subject to age-based limits. Screening for individuals under 21 years of age is not reimbursable except when criteria apply such as a previous abnormal cytology result or positive HPV test, or when the individual is otherwise high risk (for example, organ transplant or DES exposure). For individuals over 65 years of age who are not high risk and who have an adequate screening history (defined as three consecutive negative Pap smears or two consecutive negative HPV tests within the prior 10 years with the most recent within 5 years), routine screening is not reimbursable.

Procedure and Test Codes; Screening Intervals

Procedure and test codesmixed

87623
87624
87625
87626
88141
88142
88143
88147
88148
88150

1–10 of 32

1/4

Screening intervals by age

Age 21–29Pap (conventional or liquid‑based) once every 3 years.

Age 30–65Any one: Pap every 3 years; OR high‑risk HPV test alone every 5 years; OR co‑testing (cytology + high‑risk HPV) every 5 years.

Over 65Routine screening not reimbursable for those not high‑risk with an adequate screening history; high‑risk individuals may follow the 30–65 frequency.

Immunocompromised individualsAny one: annual cervical cytology for individuals of all ages; OR co‑testing (cytology + high‑risk HPV) once every 3 years for individuals ≥30 years.

Provider Responsibilities and Denial Risk

Billing Rule

Codes subject to reimbursement criteria

Listed procedure and diagnosis codes are subject to plan reimbursement criteria and claim review. Inclusion of a code does not guarantee it is a covered service or eligible for reimbursement. Providers should verify coverage and prior authorization requirements with the member's plan before submitting claims.

Procedure codes are subject to plan reimbursement criteria and claim edits.
Inclusion in the policy code list is informational and not a guarantee of payment.

Note

(Action required: review source policy for any missing provider-facing instructions and update local billing workflows as needed.)

Key Definitions

Adequate screening history

DefinitionAdequate screening history is defined as either three consecutive negative Pap smears or two consecutive negative HPV tests within 10 years, with the most recent test within 5 years.

Three negative Pap smearsThree consecutive negative Pap results prior to cessation of screening.

Two negative HPV testsTwo consecutive negative HPV test results within the 10 years before stopping screening, with the most recent within 5 years.

Background

Cervical cancer screening relies on cytology (Pap) and high-risk HPV testing, either alone or performed together (co-testing). The policy distinguishes reimbursable approaches by clinical circumstance and risk: standard interval screening is governed by age and risk factors, while more frequent testing may be reimbursable for individuals with prior abnormal results or defined high-risk conditions (for example, organ transplant or DES exposure). The document also notes that technologies outside of conventional cytology and high-risk HPV testing are not reimbursable.