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Medical Necessity Rules for HPV Testing

1-29-10 Cytology Services at MJH would like to remind offices and physicians that HPV was added to the list of tests/procedures that fall under the Medicare Medical Necessity rules. Orders for HPV as a screening test on Medicare cases always require an Advanced Beneficiary Notice (ABN). The HPV requirements differ from the Pap requirements in which an ABN can be waived if it has been more than 2 years since the previous Pap.  Note: Please write “last pap>2 years” on these cases.

A couple of other useful pieces of info:

  • Reflex HPV do NOT require an ABN.  (HPV is only done if the Pap is ASCUS which is a diagnosis not requiring an ABN).
  • If the Pap is NOT screening (ICD9 code for recent dysplasia, ASCUS, malignancy), the ABN is not needed for the Pap or HPV.

If you have any questions, please call Cytology at 434-654-7775.