Cervical Mapping Reimbursement
Updated: Sep 23, 2021
With the advent of AI-driven imaging and diagnostics, insurance companies have updated add-on billing codes so that physicians can be reimbursed for these new services, including AI-driven cervical mapping. Effective starting January 2021, the American Medical Association (AMA) granted a Category I, Current Procedural Terminology (CPT) add-on code with the support of the American College of Obstetricians and Gynecologists (ACOG) to reimburse the cervical mapping service that is performed during the cervical precancer screening.
When screening for cervical precancer, cervical mapping technology visually quantifies the cellular response to the acetic acid wash. Upon capturing the image, visual inspection algorithms calculate the speed, intensity, and duration of the acetowhitening effect within seconds. Similar to a heatmap, the cervical map places colors of varying intensity to show a color-coded summary of the quantified acetowhitening effect of the patient’s cervix. This visualization draws the physician’s attention to any potentially abnormal cells that may require a biopsy.
Healthcare practitioners can use the new CPT add-on code +57465 for computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect. Not meant to be used alone, remember to list this code in addition to the primary colposcopy code.
Physicians who work for medical groups and health organizations may get paid in work RVUs. Each CPT code has a work RVU that’s established in the Centers for Medicare and Medicaid Services' (CMS) annual Medicare Physician Fee Schedule. It’s important because it translates to compensation. In the 2021 Medicare Physician Fee Schedule, the cervical mapping procedure has a work RVU of 0.81. Private health insurers typically rely on Medicare's approved RVUs to determine the base and multiplied conversion factor to pay contracted physicians. Be sure to review your contract to understand how work RVUs are considered in your compensation rates. The Medicare Physician Fee Schedule is updated annually and subject to change.
2021 Medicare Physician Fee Schedule
Non Facility Practice Expense RVU
Facility Practice Expense RVU
Malpractice Expense RVU
Total Non Facility (Office) Based RVU
Total Facility Based RVU