CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABOO2

Cervical Cancer Screening — Clinical reimbursement criteria and coding guidance

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Clinical reimbursement criteria and coding guidance for cervical cancer screening tests (Pap smear, high-risk HPV testing, and co-testing) for individuals with a cervix, as applied by Blue Cross Blue Shield of Texas.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLABOO2

Change TypeMaterial updates to criteria and coding (adds immunocompromised, revises age-based testing, adds HPV‑16/18 testing, adds code 87626)

Effective DateFeb 5, 2025

Last ReviewFeb 5, 2025

Next Review Date

Key ActionVerify procedure codes and product-specific coverage requirements before billing; inclusion of a code does not guarantee coverage.

SourceLink

POLICY UPDATE CHANGES

Immunocompromised was added to reimbursement criterion #1.

Criterion 1a was revised to state annual cervical cytology testing applies to individuals of all ages (was individuals less than 30 years of age).

Criterion 1b was revised to specify high-risk HPV testing.

The phrase 'or individuals who are immunocompromised' was removed from reimbursement criterion #4.

Nucleic acid testing for HPV-16 and HPV-18 was added for HPV positive / cytology negative individuals.

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

Procedure code 87626 was added to the codes list.

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CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABOO2

Cervical Cancer Screening — Clinical reimbursement criteria and coding guidance

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Texas Policy CPCPLABOO2 alerts

Get alerted when Policy CPCPLABOO2 changes without checking for updates manually.

Monitor payer policy activity

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Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCervical Cancer Screening

Policy CodePolicy CPCPLABOO2

Change TypeMaterial updates to criteria and coding (adds immunocompromised, revises age-based testing, adds HPV‑16/18 testing, adds code 87626)

Effective DateFeb 5, 2025

Last ReviewFeb 5, 2025

Next Review Date

Key ActionVerify procedure codes and product-specific coverage requirements before billing; inclusion of a code does not guarantee coverage.

SourceLink

POLICY UPDATE CHANGES

Immunocompromised was added to reimbursement criterion #1.

Criterion 1a was revised to state annual cervical cytology testing applies to individuals of all ages (was individuals less than 30 years of age).

Criterion 1b was revised to specify high-risk HPV testing.

The phrase 'or individuals who are immunocompromised' was removed from reimbursement criterion #4.

Nucleic acid testing for HPV-16 and HPV-18 was added for HPV positive / cytology negative individuals.

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

Procedure code 87626 was added to the codes list.

Coverage Criteria for Cervical Cancer Screening

Age- and risk-based coverage

Covered when meeting the following age- and risk-based criteria:

Immunocompromised individuals

Options: 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.

Ages 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 reimbursable.

Ages 30-65 average risk: For individuals 30 to 65 years of age, any one of the following cervical cancer screening techniques may be reimbursable: a) Conventional or liquid based smear once every 3 years. b) Cervical cancer screening using the high-risk HPV test alone once every 5 years. c) Co-testing (cytology with concurrent high-risk HPV testing) once every 5 years.

Over 65 high risk: 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 frequency described for ages 30-65 may be reimbursable.

HPV positive, cytology negative: For individuals who are HPV positive and cytology negative, nucleic acid testing for high-risk strains HPV-16 and HPV-18 may be reimbursable.

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

Cervical cancer screening is 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, at any age. The policy also identifies additional non-reimbursable technologies including the inclusion of low-risk HPV strains in co-testing. Providers should confirm that claims for these situations will be denied per policy guidance.

Routine cervical cancer screening is not reimbursable for individuals under 21 years of age. For individuals over 65 years of age who are not high risk and who have an adequate screening history, routine screening is also not reimbursable. The policy defines adequate screening history as either two consecutive negative HPV tests within 10 years with the most recent within 5 years or three consecutive negative Pap smears. Exceptions allowing continued screening beyond these limits include individuals over 65 who are high risk and other scenarios listed in the reimbursement criteria.

Coding and Screening History Requirements

Codes listed in policymixed

87623
87624
87625
87626
88141
88142
88143
88147
88148
88150

1–10 of 11

1/2

Adequate screening history before cessation

Definition of adequate screening historyTwo consecutive negative HPV tests within 10 years before cessation, with the most recent test within 5 years

Alternate adequate historyThree consecutive negative Pap (smear) tests

PurposeUsed to determine when routine screening may be stopped for individuals over 65 who are not high risk

Provider Actions, Billing, and Denials

Billing Rule

Procedure codes (verify coverage)

The following procedure codes are provided for billing reference only. Inclusion in this list does not guarantee coverage or reimbursement. Providers must verify member eligibility, plan benefits, and any prior authorization requirements before submitting claims.

Procedure codes listed are not all-inclusive; verify coverage with the member's plan and benefit document.
Providers must bill using valid HIPAA-approved code sets and follow industry coding guidelines (CPT, HCPCS, ICD-10-CM/PCS, NDC, DRG, CMS NCCI edits).
Claims are subject to code-edit protocols and may be reviewed; submit supporting documentation upon request.

Documentation Required

Providers are responsible for submission of accurate documentation and must use valid HIPAA-approved codes when filing claims. If a conflict exists between this policy and a member's plan document or a provider contract, the plan document or provider contract governs. Blue Cross and Blue Shield of Texas (BCBSTX) may exercise reasonable discretion in interpreting and applying this policy.

Definitions

'Individual(s)' — definition

Scope of term 'individual(s)'Refers specifically to individuals with a cervix

ContextUsed throughout the reimbursement criteria to specify applicability of cervical cancer screening guidance

Implication for coverageAll age- and risk-based screening rules apply only to persons with a cervix

Background and Guideline Alignment

This policy aligns Blue Cross Blue Shield of Texas reimbursement with major professional recommendations including the U.S. Preventive Services Task Force and relevant specialty organizations. It defines the clinical scope to cover cervical cancer screening modalities for individuals with a cervix, including cervical cytology (Pap smear), high-risk HPV testing, and co-testing, and specifies age- and risk-based intervals and exceptions for immunocompromised and high-risk populations.