MedicaidCoverageMedium impact
North Carolina Medicaid: Test for routine cervical cancer screenings
UnitedHealthcare·NC · OB-GYN, Family Medicine, Internal Medicine·State news
Effective date
Dec 1, 2025
We identified it
Jan 12, 2026
Summary
North Carolina Medicaid now covers FDA-approved self-collected high-risk HPV testing for routine cervical cancer screening in women ages 30-64 when cervical specimens cannot otherwise be obtained. Providers should use CPT codes 87624 or 87626 and follow specific patient eligibility criteria and result management guidelines.
Action Required
Immediately: Billing team should verify lab providers offer FDA-approved self-collection kits and ensure use of CPT codes 87624 or 87626 for self-collected hrHPV testing to meet HEDIS compliance. Providers must verify patient eligibility (ages 30-64, no symptoms, not HIV positive, no cervical cancer history) before offering self-collection option. Update encounter forms to include eligibility checklist and result management protocols.