Anthem Blue Cross Connecticut CG-MED-53 Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing Form

This document addresses cervical cancer screening and testing for human papillomavirus (HPV) to assess cervical cancer risk. Cervical cancer screening is comprised of cervical cytology with Papanicolaou testing (also known as a ‘Pap test’) and testing for HPV DNA. Pap tests are used to identify pre-cancerous or cancerous tissues present on the cervix. Screening for HPV aids in identifying individuals at higher risk for developing cervical cancer.

Note: This document addresses the use of cervical cancer screening in the general population. It does not address the use of cervical cancer screening technologies or procedures for the work-up or surveillance of either individuals with known precancerous lesions or a known history of cervical cancer.

Note: For additional information on cervical cancer screening, please see:

• ADMIN.00002 Preventive Health Guidelines
• MED.00087 Optical Detection for Screening and Identification of Cervical Cancer

Clinical Indications

Medically Necessary:

Cervical cancer screening with cytology is considered medically necessary for individuals* who are 21 years of age or older.  

Screening for the presence of HPV is considered medically necessary for individuals* who are 30 years of age or older.  

Not Medically Necessary:

Cervical cancer screening with cytology is considered not medically necessary when the criteria above have not been met.

Screening for the presence of HPV is considered not medically necessary when the criteria above have not been met.

*The term “individual” in this document refers to any person with an intact cervix, regardless of gender identity.