CPT codes for high-risk HPV detection by type and/or subtype
For 2015, two new CPT codes were established by the American Medical Association to describe high-risk HPV genotype detection by DNA or RNA. These new codes may be used to describe testing for high-risk HPV types and/or subtypes rather than coding by test method per the previous CPT codes (eg, amplified probe, direct probe, etc.,).
The most recent (2016) Medicare national payment rate for each of the CPT codes is $47.80. Local rates may vary. Private payer rates for the new codes will also vary.
The CPT codes and descriptors are:
The cobas® HPV Test is FDA-approved to simultaneously provide pooled results on high-risk genotypes and individual results on the highest-risk genotypes, HPV 16 and HPV 18. With the option of delivering 3 results in 1 test run, the cobas® HPV Test frees laboratories from the burden of confirming payer coverage for reflex genotyping. This also allows clinicians to get more clinically relevant information up front while patients will receive better, less costly care.
Moreover, coverage for women’s preventative services was expanded due to recent changes to the Affordable Care Act (ACA). Under the ACA, private insurance plans that took effect or were significantly changed after March 23, 2010 are subject to the requirements, which include coverage of hrHPV testing with no cost sharing for women 30 years and older with normal cytology results.
Although specific hrHPV DNA tests are not identified by name by The Department of Health and Human Services (HHS), the cobas® HPV Test provides the service described by HHS. Read more about the ACA and a list of covered women’s preventive services by visiting the U.S. Department of Health and Human Services Women’s Preventive Services Guidelines.
For the latest reimbursement information on the cobas® HPV Test, please contact the Roche Molecular Diagnostics reimbursement inquiry line at 1-866-805-9155 or via email at [email protected].
Note: This information is provided as a courtesy for informational purposes only and is not intended to be, and should not be interpreted as, reimbursement or billing advice. Health care professionals are responsible for determining appropriate reimbursement policies, including applicable CPT code assignment. Roche Diagnostics Corporation does not guarantee third-party coverage or payment for Roche products or provide remuneration to customers for claims that are denied by third-party payers.
1. Current Procedural Terminology (CPT®) copyright 2014 American Medical Association. All rights reserved.