Description
The pap smear is used as the primary screening test to detect cervical cancer in asymptomatic women. It can also detect premalignant and malignant changes of the cervix or vagina and some changes due to noncancerous conditions such as inflammation from infections.
Policy Position Coverage is subject to the specific terms of the member’s benefit plan.
Criteria
Diagnostic pap smears may be considered medically necessary for ANY of the following indications (this is not an all-inclusive list):
- Abnormal vaginal bleeding or discharge; or
- Cervical ulcerations; or
- Chronic Cervicitis; or
- Condyloma; or
- Endometriosis; or
- Fibroma of cervix; or
- Follow-up to previous or suspicious pap smear; or
- Menopausal syndrome; or
- Neoplastic disease; or
- Pelvic malignancy; or
- Polyps or cysts, cervical or uterine; or
- Post-menopausal bleeding; or
- Pregnancy; or
- Vaginal or vulvar lesions, any type; or
- Vaginitis, any type; or
- Vulvitis and vulvovaginitis; or
- Women exposed to DES (Diethylstilbestrol) prior to birth.
Cyto-hormonal study is used primarily to determine the need for, or possible response to, estrogen therapy and to evaluate the hormonal status in individuals who have certain types of endocrine problems (e.g., failure to ovulate, possible abnormal sexual development, infertility, etc.)
Claims for pap smears with diagnoses/conditions other than those listed above will be denied as not medically necessary.
Procedure Codes
88141
|
88142
|
88143
|
88147
|
88148
|
88150
|
88152
|
88153
|
88155
|
88164
|
88165
|
88166
|
88167
|
88174
|
88175
|
