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«PacifiCare’s medical management guidelines represent the recommendation of the PacifiCare Medical Management Guideline (MMG) committee. They are ...»

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Brotzman GL, Kretzchmer S, Ferguson D, et al. Costs and outcomes of PAPNET secondary screening technology for cervical cytologic evaluation. Arch Fam Med. 1999;8(1):52-55.

Clavel C, Masure M, Bory JP, et al. Hybrid Capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999;80(9):1306-1311.

Confortini M, Bonardi L, Bulgaresi P, et al. A feasibility study of the use of the AutoPap screening system as a primary screening and location-guided rescreening device. Cancer. 2003;99(3):129-134.

Coste J, Cochand-Priollet B, de Cremoux P, et al. Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening. BMJ. 2003;326(7392):733.

Costa S, Sideri M, Syrjanen K, Terzano P, De Nuzzo M, De Simone P, mCristiani P, Finarelli AC, Bovicelli A, Zamparelli A, Bovicelli L. Combined Pap smear, cervicography and HPV DNA testing in the detection of cervical intraepithelial neoplasia and cancer. Acta Cytol. 2000 May-Jun;44(3):310-8.

Cronje HS, Parham GP, Cooreman BF, de Beer A, Divall P, Bam RH. A comparison of four screening methods for cervical neoplasia in a developing country. Am J Obstet Gynecol. 2003 Feb;188(2):395-400.

Cuzick J, Beverley E, Ho L, et al. HPV testing in primary screening of older women. Br J Cancer. 1999;81(3):554-558.

Cuzick J, Clavel C, Petry KU, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer; 2006 2006 Sep 1;119(5):1095-101.

Cervical Cancer Screening - Commercial Medical Management Guideline Denny L, Kuhn L, Risi L, Richart RM, Pollack A, Lorincz A, Kostecki F, Wright TC Jr. Two-stage cervical cancer screening: an alternative for resource-poor settings. Am J Obstet Gynecol. 2000 Aug;183(2):383-8.

DLA, Kabawat SE. Performance of a fluid-based, thin-layer Papanicolaou smear method in the clinical setting of an independent laboratory and an outpatient screening population in New England. Arch Pathol Lab Med. 1999;123:817-821.

Doornewaard H, Woudt JM, Strubbe P, et al. Evaluation of PAPNET-assisted cervical rescreening. Cytopathology.

1997;8(5):313-321.

Edwards G, Rutkowski C, Palmer C. Cervical cancer screening with Papanicolaou smear plus speculoscopy by nurse practitioners in a health maintenance organization. J Lower Genital Tract Dis. 1997;1:141-147.

Ferenczy A, Robitaille J, Franco E, et al. Conventional cervical cytologic smears vs. ThinPrep smears: a paired comparison study on cervical cytology. Acta Cytol. 1996;40(6):1136-1142.

Ferreccio C, Bratti MC, Sherman ME, Herrero R, Wacholder S, Hildesheim A, Burk RD, Hutchinson M, Alfaro M, Greenberg MD, Morales J, Rodriguez AC, Schussler J, Eklund C, Marshall G, Schiffman M. A comparison of single and combined visual, cytologic, and virologic tests as screening strategies in a region at high risk of cervical cancer. Cancer Epidemiol Biomarkers Prev. 2003 Sep;12(9):815-23 Ferris DG, Schiffman M, Litaker MS. Cervicography for triage of women with mildly abnormal cervical cytology results.

Am J Obstet Gynecol. 2001 Oct;185(4):939-43.

Ferris DG, Litaker MS, Macfee MS, Miller JA. Remote diagnosis of cervical neoplasia: 2 types of telecolposcopy compared with cervicography. J Fam Pract. 2003 Apr;52(4):298-304.

Hayes Inc. Medical Technology Directory. Thin-Layer Pap Preparations for Detecting Cervical Cancer. Hayes Inc; Lansdale, PA: November 30, 2003. Last update December 14, 2007. Archived November 12, 2008.

Hayes Inc. Medical Technology Directory. Hybrid Capture HPV Testing for Cervical Cancer. Hayes Inc; Lansdale, PA:

February 6, 2004a. Last update February 24, 2009.

Hayes Inc. Medical Technology Directory. Computer-Assisted Screening Methods for Detecting Cervical Cancer. Hayes Inc; Lansdale, PA: July 9, 2004b. Last update July 25, 2008.

Howard M, Sellors JW, Lytwyn A, Roth P, Mahony JB. Combining human papillomavirus testing or cervicography with cytology to detect cervical neoplasia. Arch Pathol Lab Med. 2004 Nov;128(11):1257-62.

Huh WK, Cestero RM, Garcia FA, et al. Optical detection of high-grade cervical intraepithelial neoclassic in vivo: results of a 604-patient study.

Am J Obstetric Gynecology. 2004; 190(5):1249-57.

Hutchinson ML, Zahniser DJ, Sherman ME, et al. Utility of liquid-based cytology for cervical carcinoma screening: results of a population-based study conducted in a region of Costa Rica with a high incidence of cervical carcinoma. Cancer.

1999;87(2):48-55.

Institute for Clinical Systems Improvement (ICSI). HPV DNA testing for the screening and monitoring of cervical cancer.

TA #056; released 10/2005. Last updated 11/1/2005. Available at: http://www.icsi.org/technology_assessment_reports_active/ta_hpv_dna_testing_for_the_screening_and_monitoring_of_cervical_cancer.html. Accessed March 10, 2009.

Cervical Cancer Screening - Commercial Medical Management Guideline Khalbuss WE, Rudomina D, Kauff ND, et al. SpinThin, a simple, inexpensive technique for preparation of thin-layer cervical cytology from liquid-based specimens: data on 791 cases. Cancer. 2000;90(3):135-142.

Koss LG, Sherman ME, Cohen MB, et al. Significant reduction in the rate of false-negative cervical smears with neural network-based technology (PAPNET Testing System). Hum Pathol. 1997;28(10):1196-1203.





Loiudice L, Abbiati R, Boselli F, et al. Improvement of Pap smear sensitivity using a visual adjunctive procedure: a cooperative Italian study on speculoscopy (GISPE). Eur J Cancer Prev. 1998;7(4):295-304.

Mango LJ, Valente PT. Neural-network-assisted analysis and microscopic rescreening in presumed negative cervical cytologic smears. A comparison. Acta Cytol. 1998;42(1):227-232.

Manos MM. HPV testing for clarifying borderline cervical smear results. BMJ. 2001;322(7291):878-879.

Minge L, Fleming M, VanGeem T, Bishop JW. AutoCyte Prep system vs. conventional cervical cytology. Comparison based on 2,156 cases. J Reprod Med. 2000;45(3):179-184.

Mitchell H, Medley G. Detection of unsuspected abnormalities by PAPNET-assisted review. Acta Cytol. 1998;42(1):260Moscicki AB, Durako SJ, Ma Y, Darragh T, Vermund SH. Utility of cervicography in HIV-infected and uninfected adolescents. J Adolesc Health. 2003 Mar;32(3):204-13.

Mould TA, Singer A, Mansell ME, Gallivan S. Cervicography to triage women with borderline or mild dyskaryotic cervical PAP smears. Eur J Gynaecol Oncol. 2000;21(3):264-6.

National Cancer Institute (NCI). Cervical Cancer Screening PDQ. Available at:

http://www.nci.nih.gov/cancertopics/pdq/screening/cervical/healthprofessional/allpages. February 26, 2009. Accessed March 10, 2009.

Nuovo J., Melnikow J., Hutchinson B., et al. Cochrane Library Document: Is cervicography a useful diagnostic test? a systematic overview of the literature. Journal of the American Board of Family Practice. 1997, 10(6), 390-397.

Nuovo J, Melnikow J, Howell LP. New tests for cervical cancer screening. Am Fam Physician. 2001;64:780-786.

Obwegeser JH, Brack S. Does liquid-based technology really improve detection of cervical neoplasia? A prospective, randomized trial comparing the ThinPrep Pap Test with the conventional Pap Test, including follow-up of HSIL cases. Acta Cytol. 2001;45(5):709-714.

O'Leary TJ, Tellado M, Buckner SB, et al. PAPNET-assisted rescreening of cervical smears: cost and accuracy compared with a 100% manual rescreening strategy. JAMA. 1998;279(3):235-237.

Pan Q, Belinson JL, Li L, et al. A thin-layer, liquid-based Pap test for mass screening in an area of China with a high incidence of cervical carcinoma: a cross-sectional, comparative study. Acta Cytol. 2003;47(1):45-50.

Parham GP, Andrews NR, Lee ML. Comparison of immediate and deferred colposcopy in a cervical screening program.

Obstet Gynecol. 2000;95(3):340-344.

Park IA, Lee SN, Chae SW, et al. Comparing the accuracy of ThinPrep Pap tests and conventional Papanicolaou smears on the basis of the histologic diagnosis: a clinical study of women with cervical abnormalities. Acta Cytol. 2001;45(4):525-531.

Cervical Cancer Screening - Commercial Medical Management Guideline Papillo JL, Zarka MA, St John TL. Evaluation of the ThinPrep Pap Test in clinical practice. A seven-month, 16,314-case experience in Northern Vermont. Acta Cytol. 1998;42(1):203-208 Patten SF Jr, Lee JS, Wilbur DC, et al. The AutoPap 300 QC System multicenter clinical trials for use in quality control rescreening of cervical smears: I. A prospective intended use study. Cancer. 1997;81(6):337-342.

Renshaw AA, Lezon KM, Wilbur DC. The human false-negative rate of rescreening Pap tests. Measured in a two-arm prospective clinical trial. Cancer. 2001;93(2):106-110.

Rosenthal DL, Acosta D, Peters RK. Computer-assisted rescreening of clinically important false negative cervical smears using the PAPNET Testing System. Acta Cytol. 1996;40(1):120-126.

Sarode VR, Werner C, Gander R, et al. Reflex human papillomavirus DNA testing on residual liquid-based (TPPT) cervical samples: focus on age-stratified clinical performance. Cancer Cytopathol. 2003;99(3):149-155.

Schneider DL, Herrero R, Bratti C, et al. Cervicography screening for cervical cancer among 8460 women in a high-risk population. Am J Obstet Gynecol. 1999 Feb;180(2 Pt 1):290-8.

Schneider DL, Burke L, Wright TC, Spitzer M, Chatterjee N, Wacholder S, Herrero R, Bratti MC, Greenberg MD, Hildesheim A, Sherman ME, Morales J, Hutchinson ML, Alfaro M, Lorincz A, Schiffman M. Can cervicography be improved? An evaluation with arbitrated cervicography interpretations. Am J Obstet Gynecol. 2002 Jul;187(1):15-23.

Schiffman M, Herrero R, Hildesheim A, et al. HPV DNA testing in cervical cancer screening: results from women in a highrisk province of Costa Rica. JAMA. 2000;283(1):87-93.

Stevens MW, Milne AJ, James KA, et al. Effectiveness of automated cervical cytology rescreening using the AutoPap 300 QC System. Diagn Cytopathol. 1997;16(6):505-512.

U.S. Preventive Services Task Force, Guidelines from Guide to Clinical Preventive Services, (Second Edition) 1996.

Screening for Cervical Cancer, pages 105-117.

van Niekerk WA, Dunton CJ, Richart RM, et al. Colposcopy, cervicography, speculoscopy and endoscopy. International Academy of Cytology Task Force Summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial. Acta Cytologica. 1998 Jan-Feb;42(1):33-49.

Vassilakos P, Carrel S, Petignat P, et al. Use of automated primary screening on liquid-based, thin-layer preparations. Acta Cytol. 2002;46(2):291-295 Vassilakos P, Schwartz D, de Marval F, et al. Biopsy-based comparison of liquid-based, thin-layer preparations to conventional Pap smears. J Reprod Med. 2000;45(1):11-16.

Wilbur DC, Bonfiglio TA, Rutkowski MA, et al. Sensitivity of the AutoPap 300 QC System for cervical cytologic abnormalities. Biopsy data confirmation. Acta Cytol. 1996;40(1):127-132.

Wilbur DC, Prey MU, Miller WM, et al. Detection of high grade squamous intraepithelial lesions and tumors using the AutoPap System: results of a primary screening clinical trial. Cancer. 1999;87(6):354-358.

Weintraub J, Morabia A. Efficacy of a liquid-based thin layer method for cervical cancer screening in a population with a low incidence of cervical cancer. Diagn Cytopathol. 2000;22(1):52-59.

Cervical Cancer Screening - Commercial Medical Management Guideline Wertlake PT, Francus K, Newkirk GR, Parham GP. Effectiveness of the Papanicolaou smear and speculoscopy as compared with the Papanicolaou smear alone: a community-based clinical trial. Obstet Gynecol. 1997;90(3):421-427.

Wright TC Jr, Denny L, Kuhn L, Goldie S. Use of visual screening methods for cervical cancer screening. Obstet Gynecol Clin North Am. 2002; 29(4):701-34 Wright TC Jr, Cox JT, Massad LS, et al. for the 2001 ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287(16): 2120-2129.

Yeoh GPS, Chan KW, Lauder I, Lam MB. Evaluation of the ThinPrep Papanicolaou test in clinical practice: 6-month study of 16541 cases with histological correlation in 220 cases. Hong Kong Med J. 1999;5(3):233-239.

Yu BK, Kuo BI, Yen MS, et al. Improved early detection of cervical intraepithelial lesions by combination of conventional Pap smear and speculoscopy. Eur J Gynaecol Oncol. 2003;24(6):495-499.

History/Updates Policy update. HCPCS codes P3000, P3001, Q0091 and CPT code 58999 added to policy. Policy 2008T0473E 3/27/2009 archived.

Policy updated with codes 0031T and 0032T deleted. Policy 2008T0473D archived 1/2/2009 12/15/2008 Policy update. CMS information updated. Coding reviewed with no changes. Policy 2007T0473C archived.

10/11/2007 Updated medical policy: Screening For Cervical Cancer. Policy approved 09/20/2007. Combined ComputerAssisted Screening For Cervical Cancer (2004T0473A), Hybrid Capture HPV Testing for Cervical Cancer (2004T0061D), Magnified Chemiluminescent Visual Exam (Speculoscopy) for Screening for Cervial Cancer (2005T0176C), Cervicography (2005T179C) and Thin-Layer Cytology For Cervical Cancer Screening (2004T0173C) into this policy. These policies have been archived. Policy posted now as implementation review has been completed Policy Reformatted including Coverage and Clinical Recommendations sections 2/18/2002 Coding The Current Procedural Terminology (CPT) codes and HCPCS codes listed in this policy are for reference purposes only.

Listing of a service code in this policy does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the benefit document.

HCPCS Codes:



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