The CSP reached out to the Medi-Cal program to urge that the policy on HPV testing be altered. Their policy had limited coverage for CPT 87264 to patients age 30 or older. Due to our advocacy that policy was altered and the notice below has been published. Labs that had previous denials for this code based upon age will have those claims automatically reprocessed retroactive to 1/1/17.
Effective retroactively for dates of service on or after January 1, 2017, the age restriction for CPT-4 codes 87624 (infectious agent detection by nucleic acid [DNA or RNA]; Human papillomavirus, high-risk types [e.g. 16, 18, 31, 33, 35 ,39, 45, 51, 52, 56, 58, 59, 68]) and 87625 (infectious agent detection by nucleic acid [DNA or RNA]; Human papillomavirus, types 16 and 18 only, includes type 45, if performed) is updated for the Medi-Cal program. The age restriction for these HPV testing and co-testing codes is updated from "30 to 65 years of age," to "21 years of age and older."
An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.
This change is based on the recommendations from the American Society of Colposcopy and Cervical Pathology (ASCCP) 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors.
This information is reflected in the following provider manual(s):