Posted in #reimbursement, Payer Updates, Payers and CPT reinbursement, Updates

North Carolina Medicaid- self collected HPV test info.

In March of 2024- FDA apprpved a self collecting HPV test.

It is a self collected HPV testing in a healthcare setting- patient uses a swab or brush in a private room (like in a doctor’s office) to collect their own vaginal sample for cervical cancer screening.

As of May 1st 2025, NC Medicaid added a new code 87624 or 87626.

87624- (2020) (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], high risk types) is eligible for reimbursement only when billed with ICD-10-CM diagnosis code Z11.51 

87626- Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), separately reported high-risk types (eg, 16, 18, 31, 45, 51, 52) and high-risk pooled result(s)


Eligibility:

-Only ages 30–64 years for routine cervical cancer screening

-No symptoms of abnormal bleeding, no active menstrual bleeding or use of vaginal products within 2 days

-Not HIV positive

-No history of cervical cancer

-Asymptomatic and eligible for primary HPV testing


Follow up recommendations based on the results:

-HPV negative – Repeat screening in 3 years

-HPV 16 or HPV 18 detected – Refer or return visit for colposcopy

-HPV types 56/59/66 detected with extended genotyping – Retest in 1 year at clinician’s discretion

-Other HPV detected with extended (or without) extended genotyping – Return visit for clinician-collected cervical specimen for cytology or dual stain


Resources:

1.American Cancer Society:  -https://cervicalroundtable.org/wp-content/uploads/2024/10/Self-Collection-Clinician-Communication-Guide.pdf

2. National Cancer Institute guidelines: https://dceg.cancer.gov/news-events/news/2025/self-collection-hpv-testing

3. NC Medicaid-

https://medicaid.ncdhhs.gov/blog/2025/05/02/changes-clinical-coverage-policy-1e-7-family-planning-services


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Posted in #reimbursement, HealthFirst, NY Providers, Prior Authorization Insurance Carrier Updates

Healthfirst removes some procedures off the prior auth list (2026)

For any DOS on Jan 1, 2026 and there after, Healthfirst will remove prior auth requirenment from the EviCore prior auth list.

Image via Healthfirst website

Please remember that member benefits (coverage vs non coverage) still applies.


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Posted in #reimbursement, EmblemHealth NY, Payer Updates, Prior Authorization Insurance Carrier Updates, Training

Emblem Health to add more DME codes to prior auth list.

Are you a a DME provider or a physician that prescribes DME for Emblem Health members? Then this blog post is for you!

Starting on for any DOS 13,2026 and thereafter the following DME codes will be added to the prior authorization list.


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