CMS Pub. 100-04, ch. 18, § 30.2

If the beneficiary does not qualify for more frequent screening based on paragraphs (2) and (3)

above, for services performed on or after July 1, 2001, payment may be made for a screening PAP

smear after 23 months have passed after the end of the month of the last covered smear. All other

coverage and payment requirements remain the same, except ICD-10-CM codes replace ICD-9-

CM codes when mandated.

30.2.1 – Screening for Cervical Cancer with Human Papillomavirus (HPV)

Testing

(Rev. 3460, Issued: 02-05-16, Effective: 07-09-16, Implementation: 03-07-16 - for non-shared MAC edits; 07-05-16 - CWF analysis and design; 10-03-16 - CWF Coding, Testing and Implementation, MCS, and FISS Implementation; 01-03-17 - Requirement BR9434.04.8.2)

See the Medicare National Coverage Determinations (NCD) Manual, Pub 100-03, Section 210.2.1

for complete coverage requirements for screening for cervical cancer with Human Papillomavirus

testing (HPV).

The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is

sufficient to add HPV testing once every five years as an additional preventive service benefit

under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction

with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate U.S.

Food and Drug Administration (FDA)-approved/cleared laboratory tests, used consistent with

FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA)

regulations.

Effective for claims with dates of service on or after July 9, 2015, payment may be made for

HCPCS G0476 (cervical cancer screening, all-inclusive HPV co-test with cytology (Pap smear) to

detect HPV DNA or RNA sequences).

For claims with date of service from July 9, 2015 through December 31, 2016, HCPCS G0476 will

be contractor priced. Beginning with date of service January 1, 2017 and after, HCPCS G0476 will

be priced and paid according to the CLFS.

G0476 will be included in the January 2017 CLFS, January 1, 2016 IOCE, the January 2016 OPPS

and January 1, 2016 MPFSD. HCPCS G0476 will be effective retroactive to July 9, 2015 in the

IOCE & OPPS.

Effective for claims with dates of service on or after July 9, 2015, payment may be made for

HCPCS G0476 (cervical cancer screening, all-inclusive HPV co-test with cytology (Pap smear) to

detect HPV DNA or RNA sequences) only when submitted with a Place of Service Code equal to

‘81’, Independent Lab or ‘11’, Office.

A. Screening Pap Smears: A/B MAC (B) Action for Submitting Claims to the Common

Working File (CWF) and CWF Edit

When a A/B MAC (B) receives a claim for a screening Pap smear, performed on or after January 1,

1998, it must enter a deductible indicator of 1 (not subject to deductible) in field 67 of the HUBC

record.

CWF will edit for screening pelvic examinations performed more frequently than allowed

according to the presence of high risk factors.