Product Lines:
EHP, Priority Partners and USFHP.

Eligible Population:
Female members 21 to 64 years of age as of December 31 of the measurement year.

Definition:
Members 21–64 years of age who were recommended for routine cervical cancer screening and were screened for cervical cancer using any of the following criteria:

• Age 24-64 who had cervical cytology performed within the last three years*.
• Age 30-64 who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last five years**.
• Age 30-64 who had cervical cytology/hrHPV co-testing performed within the last five years**.

* Three year look back requires 21 years or older on test date.
** Five year look back requires age 30 or older on test date.

New for CCS-E Measure: Stratification by race and ethnicity.

Continuous Enrollment:

• Commercial: The measurement year and the 730 days prior to the measurement year.
• Medicaid: The measurement year.

Best Practice and Measure Tips

• All tests require date and result.
• Request results for tests performed by another provider.
• Complete test during well woman OB/GYN visit, sick visits, urine pregnancy tests, UTI or screening for STDs.
• Review and document your patient’s surgical and preventive screenings history with results
• Use correct diagnosis and procedure codes

Acceptable:

• Member reported information documented in the patient’s medical record is acceptable as long as there is a date and result of the test or a date of the hysterectomy and acceptable documentation of no residual cervix. The member reported information must be logged in the patient’s chart by a care provider.
• Generic documentation of "HPV test" can count as evidence of hrHPV test.
• Lab results that indicate sample contained "no endocervical cells" may be used if a valid result was reported for test.
• Lab test wording Ecto/Endo/Vaginal Pool: liquid based
• Any cervical cancer screening method that includes collection and microscopic analysis of cervical cells.
• The doctor may document date test done and the result. If date of test stated is “last month,” “last year” etc.
  • Pap Smear/ hrHPV done Jan 20XX-negative – document 1/31/XX
• HM (Health Maintenance) section of chart if test date and result noted.

Not acceptable:

• Biopsies or Lab results that indicate inadequate sample or no cervical cells.
• Biopsies are considered diagnostic and do not meet the measure requirement.
• Referral to OB/GYN alone does not meet the measure.
• hrHPV test: DNA reflex test ordered, test not performed.
  • Reflex tests are only completed when the initial Pap test is abnormal.

Measure Exclusions

Required Exclusions:

• Palliative Care
• Members in hospice or using hospice services anytime during the measurement year.
• Hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix any time during the member’s history through December 31 of the measurement year.
• Members who died any time during the measurement year.

Acceptable Exclusion:

• Documentation of a “vaginal Pap smear” with documentation of hysterectomy.
• Documentation of “vaginal hysterectomy” without further specification.
• Documentation of hysterectomy and documentation that a member no longer needs Pap testing/cervical cancer screening.
  • Documentation must be from the same provider.
• Documentation of “complete”, “total” or “radical” hysterectomy (abdominal, vaginal or unspecified) - implies no residual cervix.
• Documentation of cervical agenesis.

Not Acceptable Exclusions:

• Documentation of hysterectomy alone does NOT meet the criteria because it does not indicate the cervix has been removed.
• Supracervical hysterectomy is not acceptable because the cervix remains intact.
• Check surgical history and physical exam notes. (Documentation of no cervix may be mentioned in the physical portion of the exam).

Exclusion Codes:

• Absence of Cervix Diagnosis 
  • ICD-10: Q51.5, Z90.710, Z90.712
• Hysterectomy with No Residual Cervix 
  • CPT: 57530, 57531, 57540, 57545, 57550, 57555, 57556, 58150, 58152, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290-58294, 58548, 58550, 58552-58554, 58570-58573, 58575, 58951, 58953, 58954, 59856, 59135
  • ICD-10: 
    • [0UTC0ZZ] Resection of Cervix, Open Approach
    • [0UTC4ZZ] Resection of Cervix, Percutaneous Endoscopic Approach
    • [0UTC7ZZ] Resection of Cervix, Via Natural or Artificial Opening
    • [0UTC8ZZ] Resection of Cervix, Via Natural or Artificial Opening Endoscopic

Measure Codes

• Cervical Cytology Lab Test
  • CPT: 88141-88143, 88147-88148, 88150, 88152, 88153, 88164-88167, 88174-88175
  • HCPCS: G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091
  • LOINC: 10524-7, 18500-9, 19762-4, 19764-0, 19765-7, 19766-5, 19774-9, 33717-0, 47527-7, 47528-5
• HPV Tests
  • CPT: 87624, 87625
  • HCPCS: G0476
  • LOINC: 21440-3, 30167-1, 38372-9, 59263-4, 59264-2, 59420-0, 69002-4, 71431-1, 75694-0, 77379-6, 77399-4, 77400-0, 82354-2, 82456-5, 82675-0, 95539-3