Trends in Benefits: HPV Testing Not Covered as Preventive

Healthcare reform has brought on many changes to the healthcare industry, and one of the benefits that has brought about significant confusion has been the coverage of preventive services in full.

Recently, our team has begun to see a trend of charges for women going for their annual exam with their OB/GYN. Upon investigation, everything has been coded as preventive for many of these exams, but the charges are coming from the lab. Though most of the labs run are coded and can be run through benefits as preventive, HPV screenings are not on the approved list for preventive coverage and are therefore not covered in full. Thus, members are finding that their exams, which they believed would be covered in full, are having some charges. We have seen this happen with multiple carriers, especially as physcians are beginning to make this screening a part of their protocol for annual exams.

So long as this screening remains off of the list of codes that must be covered in full for preventive services and physicians continue to make this a part of their protocol, members will most likely continue to see this charge during their annual exam.

UPDATE: Please see our article on new women's preventative services