In This Section      
 

Cervical Cancer Screening

EHP, Priority Partners, and USFHP. Female members 21 to 64 years of age.

Female members age 21-64 who were screened for cervical cancer using 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.

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.

Exclusion Acceptable:

  • Documentation of a “vaginal Pap smear” with documentation of hysterectomy.
  • Documentation of hysterectomy and documentation that a member no longer needs Pap testing/cervical cancer screening.

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.

Measure Exclusions

Required Exclusions:

  • Palliative Care
  • Hospice

Optional Exclusions:

  • Hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix.
  • Acquired absence of both cervix and uterus.
  • Partial hysterectomy can only be used if absence of cervix is documented.

Documentation of a “hysterectomy” alone will not meet the intent of the exclusion. The documentation must include the words “total,” “complete” or “radical” abdominal or vaginal hysterectomy.

Optional Exclusion Timeframe: Any time in a member’s history through December 31 of the measurement year.

Measure Codes

  • Cervical Cytology Lab Test
    • CPT: 88141-43, 88147-48, 88150, 88152-54, 88164-67, 88174-75
    • HCPCS: G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091
  • HPV Tests
    • CPT: 87620-87622, 87624, 87625
    • HCPCS: G0476
  • Hysterectomy with No Residual Cervix
    • CPT: 51925, 56308, 57540, 57545, 57550, 57555,57556, 58150, 58152, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58267, 58270, 58275, 58280, 58285, 58290-58294, 58548, 58550, 58552-58554, 58570-58573, 58575, 58951, 58953, 58954, 59856, 59135
    • ICD-10: OUTC0ZZ, OUTC4ZZ, OUTC7ZZ, OUTC8ZZ
  • Absence of Cervix Diagnosis
    • ICD-10 Q51.5, Z90.710, Z90.712