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AetnaAll Plans · Coverage · Medical Policy · OB-GYN, Family MedicineMedium impact

Cervical Cancer Screening and Diagnosis (CPB 0443, reviewed 2026-07-22)

Effective date
Not stated in the notice
Identified
Aug 15, 2026

Summary

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.

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What to do

Action · 8 steps
01Claims for cervical cancer screening in non-hysterectomized women aged 21 to 29 years need cervical cytology alone every 3 years.
02Claims for non-hysterectomized women aged 30 to 65 years need primary high-risk HPV testing every 5 years, or cotesting (cytology with hrHPV testing) every 5 years.
03Routine cervical cancer screening is not medically necessary for women who had a complete (total) hysterectomy for benign disease or who have an absent cervix.
04Claims for diagnostic Pap smears need documentation of a malignancy of the female genital tract, or of symptoms or a disease requiring diagnosis by Pap smear (such as abnormal vaginal bleeding or discharge, chronic cervicitis, a vaginal tumor, or follow-up after gynecological surgery for cancer), or of a listed risk factor (history of cervical, vaginal or vulvar cancer, HIV infection, history of genital HPV infection, immunosuppression, multiple sexual partners, previously abnormal Pap smear, or previous sexually transmitted disease).
05HPV testing as a primary screening test in women younger than 30 years of age is considered experimental, investigational, or unproven.
06AI-based cervical cancer screening, urine-based tests, and methylation markers for cervical cancer screening are listed as not covered for the indications in the bulletin.
07Pap smear screening for women under 21 years of age is considered to have no proven value unless the criteria for abnormal Pap smear history are met.
08More frequent screening, such as annual Pap smears, may be covered where required by state mandates or when the member's plan provides for such coverage.

Codes mentioned

8762487625876268762388141881428814388147881488815088152881538815488155881648816588166881678817488175574205742157465G0101G0476P3000P3001Q0091G0123G0124Z12.4Z11.51R87.810R87.820Z01.419Z01.42

Original notice

Cervical Cancer Screening and Diagnosis (CPB 0443, reviewed 2026-07-22)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOB-GYNFamily MedicineCode 87624Code 87625Code 87626Code 87623Code 88141Code 88142Code 88143Code 88147Code 88148Code 88150Code 88152Code 88153Code 88154Code 88155Code 88164Code 88165Code 88166Code 88167Code 88174Code 88175Code 57420Code 57421Code 57465Code G0101Code G0476Code P3000Code P3001Code Q0091Code G0123Code G0124Code Z12.4Code Z11.51Code R87.810Code R87.820Code Z01.419Code Z01.42

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