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Billing and Coding: Screening for Cervical Cancer with Human Papillomavirus (HPV)
A58216
Novitas Solutions, Inc. (J12)
Effective: June 4, 2020
Updated: December 6, 2025
Policy Summary
Screening for cervical cancer with HPV is covered per NCD 210.2.1 but must be billed with HCPCS G0476 (do not report CPT 87624 for screening). Claims require dual ICD‑10 codes—primary Z11.51 plus either Z01.411 or Z01.419—and non‑covered services must be billed with the appropriate modifier.
Covered Medical Codes
This policy references 5 medical codes
1
HCPCS
4
ICD-10-CM
Sample Codes
G0476Hpv combo assay ca screencovered