CPT 87624 is referenced in 10 tracked payer policy changes from UnitedHealthcare, Aetna, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 87624 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
North Carolina Medicaid now covers FDA-approved self-collected high-risk HPV testing for routine cervical cancer screening in women ages 30-64 when cervical specimens cannot otherwise be obtained. Providers should use CPT codes 87624 or 87626 and follow specific patient eligibility criteria and result management guidelines.
Arizona Medicaid now covers FDA-approved self-collected high-risk HPV testing for routine cervical cancer screening in women ages 30-64 when cervical specimens cannot otherwise be obtained. Use CPT codes 87624 or 87626 for billing and follow specific patient eligibility criteria and result management guidelines.
Aetna Clinical Policy Bulletin 0760 on oral screening and lesion identification systems states that AI-based technology, Epstein-Barr virus testing for screening for oral squamous cell carcinoma, oral HPV testing for all indications, several salivary biomarker tests, and tumor-derived exosomal biomarkers are considered experimental, investigational or unproven. The policy also lists tools for early detection of oral cancer and other indications, including ViziLite-Blue, VELscope, narrow band imaging and confocal laser endomicroscopy, and its code tables list the related CPT and HCPCS codes as not covered for the indications listed in the policy.
New York State Medicaid now covers HPV testing (provider-collected or patient self-collected specimens in healthcare settings) for both FFS and Managed Care plans. Clinical laboratories can bill directly using CPT codes 87623-87626, and providers may continue billing E&M services when appropriate. Self-collection is not recommended for immunocompromised patients who require both HPV and cytology testing.
Aetna's Clinical Policy Bulletin CPB 0443 sets the medical necessity rules for cervical cancer screening and diagnosis. For women aged 21 to 29 years, screening every 3 years with cervical cytology alone is considered medically necessary for non-hysterectomized women, and for women aged 30 to 65 years, primary cervicovaginal screening every 5 years with clinician- or self-collected high-risk HPV testing, or cotesting every 5 years, is considered medically necessary. The bulletin considers Pap smear screening not medically necessary for women who had a complete (total) hysterectomy for benign disease, and lists AI-based screening, urine-based tests, methylation markers and several other methods as experimental, investigational, or unproven.
Oral screening and lesion identification systems are considered experimental, investigational, or unproven because the effectiveness of these approaches has not been established. This covers artificial intelligence-based technology, Epstein-Barr virus testing for screening for oral squamous cell carcinoma, oral HPV testing (for example the OraRisk HPV Salivary DNA Test) for all indications, several salivary biomarker tests for screening and detecting oral squamous cell carcinoma, salivary hyper-methylated DNA biomarkers for detecting oral cancer, salivary metabolite biomarkers, and tumor-derived exosomal biomarkers from a liquid biopsy for early detection of oral cancer. For early detection of oral cancer and other indications, the following are also considered experimental, investigational, or unproven: chemiluminescence, confocal laser endomicroscopy, diffuse reflectance spectroscopy, fluorescence spectroscopy, MOP genetic testing, narrow band imaging, the optical filter for auto-fluorescence glasses (GOCCLES), optical fluorescence imaging, oral lesion identification systems (including the Dentlight Oral Exam Light Kit, Microlux DL, Orascoptic DK, Sapphire Plus, TRIMIRA Identafi 3000, ViziLite-Blue and VELscope), Straticyte, and wide-field and high-resolution in-vivo imaging. The listed CPT and HCPCS codes are not covered for the indications listed in CPB 0760, and the listed ICD-10 codes are not covered for those indications either.
EmblemHealth issued guidance for Cervical Health Awareness Month highlighting preventive care and providing specific billing codes for cervical cytology and HPV testing. This is informational guidance to promote cervical cancer screening and ensure proper coding compliance.
EmblemHealth emphasizes cervical cancer screening as a quality measure for Cervical Health Awareness Month in January. The policy provides specific CPT and HCPCS billing codes for cervical cytology and HPV testing, along with screening timeframes and documentation requirements for women ages 21-64.
EmblemHealth emphasizes cervical cancer screening compliance during Cervical Cancer Awareness Month, specifying required screening timeframes and documentation requirements. Billing teams must use specific CPT and HCPCS codes for cervical cytology and HPV testing to ensure proper reimbursement.
Nucleic acid probe testing without quantification of viral load may be considered medically necessary for listed organisms including Bartonella henselae and quintana, Bordetella pertussis, Candida species, Chlamydia, Clostridium difficile, Herpes simplex virus, influenza virus, Mycobacterium tuberculosis, Neisseria gonorrhoeae, Streptococcus group A and group B, Trichomonas vaginalis and Zika virus. Probe testing with or without quantification may be considered medically necessary for cytomegalovirus, hepatitis B and C, HIV-1, HIV-2 and human herpes virus 6, and quantification is investigational for organisms not on that list. Nucleic acid testing with a direct or amplified probe for Gardnerella vaginalis and Hepatitis G is considered investigational, and pathogen panel testing is addressed in the Pathogen Panel Testing medical policy.
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