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New York State Medicaid Coverage of Human Papillomavirus Testing
Act
immediately
Effective date
Not stated in the notice
Identified
Sep 17, 2026
Summary
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.
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What to do
immediately · 6 steps
01Billing team must update billing system to recognize and properly bill CPT codes 87623, 87624, 87625, and 87626 for HPV testing performed by NYS Medicaid-enrolled clinical laboratories.
02Ensure clinical laboratories are configured to bill NYS Medicaid directly for HPV testing reimbursement.
03Update provider education materials to clarify that E&M services can still be billed when all required elements are met, and that self-collection is contraindicated for high-risk/immunocompromised patients.
04For FFS coverage questions, direct providers to call (518) 473-2160 or email FFSMedicaidPolicy@health.ny.gov.
05For billing/claims questions, reference the eMedNY Call Center at (800) 343-9000.
06For Managed Care plans, coordinate with the specific MMC Plan.
If missed: Failure to bill correct codes may result in claim denials or processing delays.
Codes mentioned
87623876248762587626
Original notice
New York State Medicaid Coverage of Human Papillomavirus Testing
health.ny.gov · Always check the source before changing claims.