We’re making some coding and benefit changes related to cervical cancer screenings, effective for dates of service beginning Jan. 1, 2027 for our Harvard Pilgrim Health Care Commercial and Tufts Health Direct products.

As a result, we’ll be updating the Patient Protection and Affordable Care Act (Federal Health Care Reform) policies in our Harvard Pilgrim Commercial and Tufts Health Public Plans Provider Manuals as of Jan. 1.

The updated PPACA policies will reflect a change to our billing requirements for cervical cancer screenings: when billing procedure codes 57500, 57420, 57421, 57452, 57454, 57455, 57456, 57460, 57461, 57465, 88305 or 88344 (biopsy, colposcopy, dual stain, pathology), providers will be required to include modifier 33 in the first modifier field and one of the following diagnosis codes in the primary position to be considered preventive under the cervical cancer screening benefit:

  • D06.0 - Carcinoma in situ of endocervix
  • D06.1 - Carcinoma in situ of exocervix
  • D06.7 - Carcinoma in situ of other parts of cervix
  • N84.1 - Polyp of cervix uteri
  • N87.0 - Mild cervical dysplasia
  • N87.1 - Moderate cervical dysplasia
  • N87.9 - Dysplasia of cervix uteri, unspecified
  • R87.610 -  Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)
  • R87.611 -  Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion on cytologic smear of cervix (ASC-H)
  • R87.612 -  Low grade squamous intraepithelial lesion on cytologic smear of cervix (LGSIL)
  • R87.613 - High grade squamous intraepithelial lesion on cytologic smear of cervix (HGSIL)
  • R87.614 - Cytologic evidence of malignancy on smear of cervix
  • R87.615 - Unsatisfactory cytologic smear of cervix
  • R87.618 - Other abnormal cytological findings on specimens from cervix uteri
  • R87.619 - Unspecified abnormal cytological findings in specimens from cervix uteri
  • R87.810 - Cervical high risk human papillomavirus (HPV) DNA test positive
  • R87.820 - Cervical low risk human papillomavirus (HPV) DNA test positive