US · guidance
CMS Pub. 100-04, ch. 18, § 30.8
MSN Messages
If there are no high risk factors, and the screening Pap smear and/or screening pelvic examination
is being denied because the procedure/examination is performed more frequently than allowed use
MSN 18.17:
Medicare pays for a screening Pap smear and/or screening pelvic examination only once
every (2, 3) years unless high risk factors are present.
HPV Screening: Effective for claims with dates of service on and after July 9, 2015:
A. If denying line-items on claims containing HCPCS G0476, HPV screening, when reported
more than once in a 5-year period [at least 4 years and 11 full months (59 months total) must elapse
from the date of the last screening], use the following messages:
(Part A Only) MSN 15.19: “Local Coverage Determinations (LCDs) help Medicare decide what is
covered. An LCD was used for your claim. You can compare your case to the LCD, and send
information from your doctor if you think it could change our decision. Call 1-800-MEDICARE
(1-800-633-4227) for a copy of the LCD”.
Spanish Version - Las Determinaciones Locales de Cobertura (LCDs en inglés) le ayudan a decidir
a Medicare lo que está cubierto. Un LCD se usó para su reclamación. Usted puede comparar su
caso con la determinación y enviar información de su médico si piensa que puede cambiar nuestra
decisión. Para obtener una copia del LCD, llame al 1-800-MEDICARE (1-800-633-4227).
MSN 15.20: “The following policies NCD 210.2.1 were used when we made this decision.”
Spanish Version – “Las siguientes políticas NCD 210.2.1 fueron utilizadas cuando se tomó esta
decisión.”
B. If denying line-items on claims containing HCPCS G0476, HPV screening, when the
beneficiary is not between the ages of 30-65, use the following messages:
(Part A Only) MSN 15.19: “Local Coverage Determinations (LCDs) help Medicare decide what is
covered. An LCD was used for your claim. You can compare your case to the LCD, and send
information from your doctor if you think it could change our decision. Call 1-800-MEDICARE
(1-800-633-4227) for a copy of the LCD”.
Spanish Version - Las Determinaciones Locales de Cobertura (LCDs en inglés) le ayudan a decidir
a Medicare lo que está cubierto. Un LCD se usó para su reclamación. Usted puede comparar su
caso con la determinación y enviar información de su médico si piensa que puede cambiar nuestra
decisión. Para obtener una copia del LCD, llame al 1-800-MEDICARE (1-800-633-4227).
MSN 15.20: “The following policies NCD 210.2.1 were used when we made this decision."
Spanish Version – “Las siguientes políticas NCD 210.2.1 fueron utilizadas cuando se tomó esta
decisión.”
C. If denying line-items on claims containing HCPCS G0476, HPV screening, when the claim
does not contain the appropriate ICD-10 diagnosis codes listed below:
ICD-10: Z11.51 and Z01.411 or, Z01.419
Use the following messages:
(Part A Only)MSN 15.19: “Local Coverage Determinations (LCDs) help Medicare decide what is
covered. An LCD was used for your claim. You can compare your case to the LCD, and send
information from your doctor if you think it could change our decision. Call 1-800-MEDICARE
(1-800-633-4227) for a copy of the LCD”.
Spanish Version - Las Determinaciones Locales de Cobertura (LCDs en inglés) le ayudan a decidir
a Medicare lo que está cubierto. Un LCD se usó para su reclamación. Usted puede comparar su
caso con la determinación y enviar información de su médico si piensa que puede cambiar nuestra
decisión. Para obtener una copia del LCD, llame al 1-800-MEDICARE (1-800-633-4227).
MSN 15.20: “The following policies NCD 210.2.1 were used when we made this decision.”
Spanish Version – “Las siguientes políticas NCD 210.2.1 fueron utilizadas cuando se tomó esta
decisión.”
History
(Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1e359168d537fd4a0c005141482e3bd2bde0c5a8fab2a1c7bda2dfbafa870314
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.