Highmark Medical Policy Bulletin |
Section: | Laboratory |
Number: | L-1 |
Topic: | Pap Smears |
Effective Date: | April 21, 2003 |
Issued Date: | April 21, 2003 |
Date Last Reviewed: | 01/2003 |
The following diagnoses/conditions are those justifying payment for pap smears. (This is not intended to be an all-inclusive list.) Abnormal vaginal discharge: 131.00 Payment may be made for pap smears performed to "rule out" a suspected condition that may be the cause of the patient's symptoms. Cyto-hormonal study (88155) is used primarily to determine the need for, or possible response to, estrogen therapy and to evaluate the hormonal status in patients who have certain types of endocrine problems (e.g., failure to ovulate, possible abnormal sexual development, infertility, etc.) Payment may be made for the cyto-hormonal study (88155) in addition to the pap smear (88142-88154, 88164-88167, 88174, 88175). Claims for pap smears with diagnoses/conditions other than those listed above should be denied on the basis of medical necessity. Individual consideration can be given if this decision is questioned. Pap smears using the ThinPrep method of slide preparation are eligible for payment under codes 88142, 88143, 88174, 88175, G0123, G0124, G0143, G0144, G0145. Pap smears supplemented with the PapNet or AutoPap computerized rescreening are eligible for payment under codes 88147, 88148, 88152, 88154, 88166, 88167, as appropriate. When reported, payment may be made for the physician interpretation (code 88141) in addition to the pap smear codes (88142-88154, 88164-88167, 88174, 88175, G0123, G0124, G0143, G0144, G0145, G0147, G0148, P3000, P3001). When a provider obtains a specimen for a pap smear, then refers that specimen to a laboratory for examination, the cost of obtaining the specimen is included in the allowance for the gynecological examination or evaluation and management service. Payment should be made to the laboratory for the actual pap smear examination. However, if there is a billing arrangement whereby the provider reimburses the laboratory for the pap smear examination, payment can be made to the provider for the pap smear. No payment should be made to the laboratory in this case. See Medical Policy Bulletin V-35 for guidelines on routine/screening pap smears. Speculoscopy Most cases of invasive cervical cancer occur in the unscreened population. However, approximately one third can be attributed to screening failure (i.e., false-negative pap smear results). Speculoscopy (PapSure) is a technology employed to augment conventional cervical cytological screening to reduce the 30% false-negative rate. Speculoscopy uses a chemoluminescent light to illuminate the cervix to aid naked-eye or minimally magnified visualization of acetowhite changes on the cervix. In addition to its use as an adjunct to the pap smear for cervical cancer screening, speculoscopy has been used as a triage method to identify which patients with low grade atypical pap smears need further evaluation by colposcopy and biopsy. Speculoscopy (0031T, 0032T) is considered to be experimental/investigational. There is insufficient scientific evidence to support the use of speculoscopy in the triage of low grade atypical pap smears or for routine screening for cervical cancer. The clinical role of speculoscopy as a screening device remains undefined. A participating, preferred, or network provider may bill the member for the denied service. |
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88141 | 88142 | 88143 | 88147 | 88148 | 88150 |
88152 | 88153 | 88154 | 88155 | 88160 | 88161 |
88162 | 88164 | 88165 | 88166 | 88167 | 88174 |
88175 | G0123 | G0124 | G0141 | G0143 | G0144 |
G0145 | G0147 | G0148 | P3000 | P3001 |
Traditional (UCR/Fee Schedule) Guidelines
Under the Federal Employee’s Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient’s condition. Speculoscopy is considered an eligible service when determined medically necessary based on the patient’s condition. |
Comprehensive/Wraparound/PPO Guidelines
Managed Care (HMO/POS) Guidelines
PRN References |
[Version 005 of L-1] |
[Version 004 of L-1] |
[Version 003 of L-1] |
[Version 002 of L-1] |
[Version 001 of L-1] |
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