The pap smear has taken screening to a whole new level. The rise in Sexually Transmitted Infection Testing has initiated changes in payers’ policies that are linked to pap smears and HPV testing. While the pap smear continues to follow age-restrictions and medical necessity guidelines for screening paps, the policies for HPV testing is being included with the pap smears and is being revamped by major payers.
United Healthcare’s Community Plan payment policy has changed in many states effective in 2023. The policy will allow for only one unit per day for CPT® 87801, when two or more single test codes for 87491, 87591, and/or 87661 are reported for the same date of service. The payment will be based on a single unit of 87801 regardless of the number of units billed. It will be important for you to know your state’s UHC policy for proper medical and billing policy requirements.
Code | Description | Comments |
87491 | Infectious agent by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique |
|
87591 | Infectious agent by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique |
|
87661 | Infectious agent by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique |
|
87801 | Infectious agent by nucleic acid (DNA or RNA); multiple organisms, amplified probe(s) technique | Requires reporting 1 unit when any two or more of codes 87491, 87591, 87661 is reported |
For more information and to view this policy online, please click the link below.
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