Coding Information

Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 999 Not Applicable Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. 99999 Not Applicable CPT/HCPCS Codes: Group 1 Paragraph: Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. Group 1 CPT Codes: G0476 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES (E.G., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) FOR CERVICAL CANCER SCREENING, MUST BE PERFORMED IN ADDITION TO PAP TEST ICD-10 Codes That Are Covered It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. The following ICD-10-CM code supports medical necessity and provides coverage for HCPCS code: G0476 Z11.51 Encounter for screening for human papillomavirus (HPV) The following ICD-10-CM diagnosis codes are secondary diagnosis codes to be reported with the primary diagnosis code in Group 1. Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings ICD-10 Codes That Are Not Covered XX000

Revision History Information

Revision History Date Revision History Number Revision History Explanation 06/04/2020 R1 Article updated on 06/25/2020 for administrative purposes. No changes have been made to the Article content.