Having Issues Being Paid for HPV Testing?

It is Medicare's and most other commercial payors' positions that HPV testing is useful in the evaluation of certain abnormal Pap smears.  The key word is "certain."

NGS Medicare reports that, "HPV testing of a cervical specimen is indicated when the Pap smear result is reported as the following:”

1.  Atypical cells of indeterminate significance (ASC-US)
2.  Atypical glandular cells (AGC)
3.  Atypical squamous cells can’t rule out high grade lesion (ASC-H).

NGS further reports that screening tests for Pap smears are covered by statute.  This means that screening paps are paid in accordance of statutory requirements; whereas, HPV testing may not be used for routine screening purposes.  Therefore, CMS (and other payors) have placed LCD's on these types of tests which identify the indications and limitations of an insurer’s coverage and reimbursement for these services.

Following is the CPT code that is assigned for HPV tests:

87621 - Infectious agent detection by nucleic acid (DNA or RNA); Papillomavirus, human, amplified probe technique.

Following are the diagnosis codes that support medical necessity:

Primary ICD9 codes (if the test result is positive, one of the secondary diagnosis codes listed below should also be reported)

795.00 - Abnormal glandular papanicolaou smear of the cervix.
795.01 - Papanicolaou smear of cervix with atypical cells of indeterminate significance (ASC-US).
795.02 - Papanicolaou smear of cervix with atypical squamous cells can’t exclude high grade squamous intraepithelial lesion (ASC-H).

Secondary diagnosis codes (indicating a positive test result)

795.05 - Cervical high risk HPV, DNA test positive.
795.15 - Vaginal high risk HPV, DNA test positive.

The claim must document the need for the test (ICD9 codes 795.0, 795.01 and/or 795.02).  If the test is positive then also report (ICD9 codes 795.05 or 795.15).  An ICD9 code denoting the test result should also be submitted.