Preventive Services

Preventive Services Guide


Screening for Cervical Cancer with Human Papillomavirus Tests

Cervical cancer is commonly caused by the HPV. The USPSTF found that regular screening greatly reduces the rate of cervical cancer and the number of related deaths.

Coverage Criteria and Frequency Limits

  • Coverage every five years for asymptomatic female patients age 30 to 65 years in conjunction with the pap smear test
    • U.S. FDA-approved/cleared laboratory tests, used consistent with FDA-approved labeling, and in compliance with the CLIA regulations
  • Effective for claims dates of service on or after 7/9/2015

HCPCS/CPT Coding

  • G0476: Infectious agent detection by nucleic acid (DNA or RNA); HPV, high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test

ICD-10 Codes

  • Z11.51 and either Z01.411 or Z01.419

Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service and contact your Medicare Administrative Contractor (MAC) for guidance.

Billing Tips

  • A covered E/M visit can be billed on the same claim as Q0091
  • Report modifier 25 on the E/M service
  • Clearly document the medical necessity of a separately identifiable E/M service in the patients’ medical record

Who Can Perform?

  • Must be ordered and collected by DM, DO or other qualified NPP
  • Qualified NPPs (certified nurse midwife, physician assistant, nurse practitioner and clinical nurse specialist)

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

Reimbursement

Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

Common Claim Denial Reasons

  • Patient not at high risk and received covered screening within past two years
  • High-risk patient received covered screening within past year

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Reviewed 9/27/2024