CMS to Cover HPV Testing With Pap Smear to Screen for Cervical Cancer

AAFP's Push for Coverage Spurs Agency's Decision

July 11, 2015 11:38 am News Staff

Just three months after CMS proposed to cover HPV testing once every five years -- in conjunction with a Pap smear test -- as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries 30 to 65 years old, the agency has finalized that decision(www.cms.gov).

[HPV word cloud]

The final decision memo explained that CMS found sufficient evidence to include HPV testing as an additional preventive benefit, and Medicare will cover screening for cervical cancer with the appropriate FDA-approved lab tests.

Action Aligns With Evidence-based Recommendations

"This decision is consistent with the best medical evidence, and provides women and their physicians more options for cervical cancer screening," said AAFP President Robert Wergin, M.D., of Milford, Neb., in a prepared statement.

Wergin explained that CMS' coverage decision aligns with the AAFP's recommendation for cervical cancer screening with Pap smear every three years in women ages 21-65 or with a combination of Pap smear and HPV testing every five years for women ages 30-65 who choose a longer screening interval. The U.S. Preventive Services Task Force (USPSTF) also issued a Grade A recommendation for these screening protocols(www.uspreventiveservicestaskforce.org), meaning that private insurers must cover them with no cost-sharing.

Story Highlights
  • CMS has made a final coverage determination regarding an additional cervical cancer screening benefit under Medicare for beneficiaries ages 30 to 65.
  • CMS will allow asymptomatic women the option of screening once every five years with HPV testing in conjunction with a Pap smear.
  • The agency's action came after the AAFP's formal request in 2014 for CMS to initiate a national coverage analysis for the screening.

"The combination of cytology with HPV testing allows women the choice to have less frequent screening without increasing their risk of developing cervical cancer," Wergin said.

AAFP Request Spurs Coverage

The AAFP played an integral role in CMS' action by first requesting this coverage be considered -- triggering a national coverage analysis (NCA) -- and then in encouraging CMS to follow through on its coverage proposal.

In CMS' final decision memo, the agency noted that the AAFP's formal request(2 page PDF) for a national coverage determination initiated the analysis that led to the decision, citing the Academy's April 24, 2014, letter on its NCA tracking sheet(www.cms.gov).

In his letter to CMS Chief Medical Officer Patrick Conway, M.D., (then) AAFP Board Chair Jeff Cain, M.D., of Denver, wrote that approving coverage for screening with a combination of Pap smear and HPV testing every five years would make Medicare coverage "consistent with the clinical recommendations of the USPSTF and AAFP."

Then, in December 2014, AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., sent a second letter(2 page PDF) to Conway applauding CMS for accepting the Academy's formal request to initiate an NCA on the issue.

In that letter, Blackwelder urged CMS to "promptly implement policy consistent with the recommendations of the USPSTF and the AAFP."

Related AAFP News Coverage
CMS Proposes Covering Pap Smear/HPV Testing For Cervical Cancer
AAFP's Proactive Stance Pays Off for Patients

(4/29/2015)

CMS to Consider Covering HPV Testing for Cervical Cancer
AAFP Request Spurs National Coverage Analysis

(12/19/2014)

Despite Prevention Tools, Cervical Cancer Still Too Common
Don't Miss Opportunities to Screen, Vaccinate, Says FP Expert

(11/25/2014)


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