Medicare Coverage Proposed for HPV Screenings

Medicare beneficiaries between the ages of 30 and 65 could be tested for Human Papillomavirus (HPV) every five years, “in conjunction with the Pap Smear test,” under a newly proposed coverage decision from the Centers for Medicare and Medicaid Services (CMS). CMS issued the proposed decision memorandum April 16, 2015, with a 30-day public comment period. CMS reports that cervical cancer “is almost always caused by a sexually transmitted infection with human papillomavirus (HPV).” HPV is also linked to other cancers such as anal, vaginal, penile, vulvar and oropharyngeal cancers. The new screening recommendation tracks the recommendation of the U.S. Preventive Services Task Force (USPSTF) which recommends Pap smears in combination with HPV testing every five years for women between 30 and 65 years old. USPSTF gives this recommendation a Grade A, meaning “[t]here is high certainty that the net benefit is substantial.” Currently, Medicare doesn’t provide reimbursement for HPV testing and only permits Pap tests for women every 12 or 24 months, depending on risk factors. The Centers for Disease Control and Prevention reports that HPV “is the most common sexually transmitted infection” with 14 million people becoming infected each year and approximately 79 million Americans currently infected. One type of HPV is credited with causing nearly all cases of cervical cancer, which affects 11 million American women each year. This coverage expansion follows closely on the heels of Medicare coverage expanded for another sexually transmitted infection — HIV. In January, CMS issued a proposed decision memorandum, soliciting public comment on a proposal to expand coverage to provide screening for the following:

• Up to one annual voluntary screening for individuals between age 15 and 65, regardless of risk;
• Up to one annual voluntary screening for those under age 15 or over 65-years old, if there is increased risk of infection such as those having unprotected intercourse, injection drug users, individuals who had blood transfusions between 1978 and 1985, individuals with new partners or partners who were HIV infected or injection drug users; and
• Up to three voluntary HIV screenings for pregnant women (at time pregnancy is diagnosed, in the third trimester and/or at labor).

Prior to that proposal, Medicare only provided for up to one annual voluntary screening for those at risk of infection and up to three voluntary screenings for pregnant women at the same times as in the proposal. After receiving 16 comments, CMS finalized that coverage decision memorandum on April 13, 2015. For both HIV and HPV, infection can occur long before symptoms arise that could alert individuals they are infected. Medicare coverage continues to expand for screening of diseases that lack early symptoms yet have potentially life-threatening consequences in the future if undetected.