California Medi-Cal FPACT HPV Testing
March 1, 2004Effective for dates of service on or after April 1, 2004, the following CPT-4 Human Papilloma Virus (HPV) procedure codes are no longer reimbursable:
| CPT-4 Code | Description |
| 87620 | Infectious agent detection by nucleic acid (DNA or RNA), papilloma virus, human, direct probe technique |
| 87622 | Quantification |
In addition, CPT-4 HPV procedure code 87621 (…amplified probe technique) is restricted as follows:
- Limited to one claim every eleven months for the same recipient, by any provider
- Screening for high-risk HPV types only
- By Report: Attach cervical cytology report indicating the presence of atypical squamous cells of undetermined significance (ASC-US) for females of all ages or non-reflex testing for females less than 21 years of age with a cervical cytology report of low-grade squamous intraepithelial lesion (LSIL)
A future update will include the revised Family PACT Policies, Procedures and Billing Instructions (PPBI) manual. For more information regarding Family PACT, call the Telephone Service Center (TSC) at 1-800-541-5555.