CPT code 87625 – HPV types 16 and 18 genotype detection

Key takeaways

CPT code 87625 reports HPV genotyping for types 16 and 18 only, and it includes type 45 if the assay tests for it.

Pooled high-risk HPV detection is 87624 and pooled low-risk detection is 87623, so the code follows the types the lab reports.

Labs usually run 87625 after a positive pooled 87624 result, so it pairs with a diagnostic code such as R87.810.

Medicare bills screening HPV tests with G0476 under NCD 210.2.1, once every five years for asymptomatic patients aged 30 to 65.

Pabau’s claims management software checks CPT and ICD-10 pairings before submission to cut denials on HPV lab claims.

CPT code 87625: Official descriptor and clinical definition

CPT code 87625 carries an official descriptor from the American Medical Association (AMA). It reads “Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed.” It sits in the microbiology section of the CPT codebook. The performing laboratory reports it, not the ordering physician’s office.

87625 is a genotyping code. It tells the clinician whether HPV 16 or 18 is present, and most labs run it after a positive pooled high-risk result. Practices running gynecology labs need billing systems that map each assay result to the right HPV code when the superbill is built.

Key points about 87625’s scope:

• Reports genotyping for HPV 16 and 18, the two types behind about 70% of cervical cancers.
• Includes type 45 in the same unit when the assay detects it, so 45 never goes on a line of its own.
• Applies to DNA and RNA assays alike, because the descriptor names both nucleic acids.
• Does not cover a pooled high-risk result, which is 87624, or a pooled low-risk result, which is 87623.
• Does not cover extended genotyping that names types beyond 16, 18 and 45 one by one. Check the lab’s coding policy and the payer’s rules for those panels.

CPT 87625 vs 87624: Key coding differences

The most common selection error in the HPV code family is billing 87625 for a pooled high-risk result, or 87624 for a 16/18 genotype. Test method plays no part in choosing between them. The HPV types named on the lab report decide the code.

The decision rule follows the types on the lab report. A single pooled high-risk result is 87624, and a pooled low-risk result is 87623. A result that names HPV 16 and 18, with or without 45, is 87625.

Some assays report the pooled result and the 16/18 genotype in one run. In that case, check the payer’s policy and the current NCCI edits before you report 87624 and 87625 together.

The genotype result often decides the next visit. Under ASCCP risk-based guidelines, a patient positive for HPV 16 or 18 is usually referred to colposcopy.

How HPV genotyping is performed and what documentation must show

CPT code 87625 reports a laboratory procedure, so the documentation burden falls on two places. Both the ordering clinician’s record and the lab’s report must support the claim.

The lab workflow runs as follows:

1. Specimen collection: Cervical cells are collected by brush or broom, usually into a liquid-based cytology vial shared with the Pap test.
2. Pooled screen: The lab runs a high-risk HPV assay, reported as 87624, or as G0476 for a Medicare screening test.
3. Genotyping: When the pooled result is positive, the lab tests for HPV 16 and 18, plus 45 where the assay includes it.
4. Result reporting: The report lists each genotype as positive or negative, and that result is what supports 87625.

The ordering clinician’s record must document the clinical indication, the prior result that prompted genotyping, and the patient’s age. It also names the ordering provider and the specimen source. A complete superbill documentation package ties the lab result back to the diagnosis code before the claim is submitted.

ICD-10 codes to pair with CPT code 87625

The right ICD-10-CM code depends on why the genotype was run. Most 87625 claims follow an abnormal or positive result, so a diagnostic code is the usual pairing.

Always verify diagnosis codes against the current CMS ICD-10-CM code files for the fiscal year, since descriptions and valid codes change annually. Some MAC jurisdictions list covered diagnosis codes in their local coverage policies, so check those as well.

Medicare coverage and reimbursement for CPT code 87625

Medicare’s preventive HPV benefit does not use CPT 87625. Screening HPV tests are covered under National Coverage Determination (NCD) 210.2.1 and billed with HCPCS code G0476, alongside a Pap test.

Key Medicare parameters for HPV testing:

• Screening (G0476): Covered once every five years for asymptomatic beneficiaries aged 30 to 65, performed with a Pap test.
• Pap tests: Medicare’s 12-month interval for higher-risk patients applies to the Pap test, not to the HPV screen.
• Genotyping (87625): Medicare may cover 87625 as a diagnostic test when the record supports medical necessity, subject to the MAC’s local coverage policy. A documented positive pooled screen is the usual support.
• Payment: Lab tests are paid under the Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule.

For the current Medicare rate, check the CMS Clinical Laboratory Fee Schedule for the calendar year. CMS updates the file every year, so verify the figure before you quote it to billing staff.

A test that falls outside covered parameters needs an Advance Beneficiary Notice (ABN) signed before the service. Without one, the lab cannot bill the patient if Medicare denies the claim.

Labs that bill through Pabau, our practice management and billing platform, can send electronic claims via Claim.MD and confirm eligibility first. Pabau’s claims management software also checks ICD-10 and CPT pairings at claim level, which catches screening-versus-diagnostic errors before the payer sees them.

Billing CPT code 87625 with Pap cytology codes (HPV cotesting)

Cotesting pairs a Pap test with a pooled high-risk HPV test, which is 87624, or G0476 for Medicare screening. 87625 joins the claim when the pooled result is positive and the lab reflexes to genotyping on the same specimen. Coding this sequence correctly prevents both undercoding and bundling denials.

Cotesting is billed with a Pap cytology code, such as 88174 or 88175, on the same date of service.

• CPT 88175: Automated thin-layer preparation, screened by an automated system with manual rescreening or review under physician supervision.
• CPT 88174: Automated thin-layer preparation, screened by an automated system under physician supervision.
• Modifier QW: Not applicable, because 87625 is not a CLIA-waived test. The lab needs a CLIA certificate of compliance or accreditation, and some payers want the CLIA number on the claim.
• Same-day billing: 87625 and 88175 can be billed on the same date. NCCI edits do not normally bundle them, but check the current quarterly edit file and the payer’s policy.
• Place of service: An outside reference lab bills with POS 81 (independent laboratory), even when the specimen was collected in the physician’s office.

Common denial reasons for CPT 87625 and how to fix them

Most CPT 87625 denials are preventable with upstream claim edits. These are the patterns that appear most often on HPV genotyping claims:

Your denial management workflows should flag any 87625 claim with no diagnostic indication before it leaves the practice. A front-end claim edit saves the 30- to 60-day turnaround of a denial and appeal cycle. Clean claim submission, which validates the code pair, prior result and eligibility before transmission, is the cheapest fix available to gynecology billing teams.

Commercial payer and Medicaid coverage considerations

Commercial payers generally follow USPSTF guidance, but each plan layers its own rules on top. Four areas create the most billing friction:

• Frequency definitions: Some plans measure the screening interval from the last paid claim rather than the last date of service. A screen can deny inside that window even when it is clinically appropriate.
• Cost-sharing scope: Under the ACA, non-grandfathered plans cover USPSTF Grade A and B screening in network without cost-sharing. A follow-up genotype may be processed as diagnostic, so the patient can still receive a bill.
• Network and lab restrictions: Some plans require HPV testing at a contracted reference lab. An out-of-network lab can see a denied or reduced claim whichever code it bills.
• Medicaid: Rules are state-specific. Some states follow Medicare’s NCD 210.2.1, while others set their own frequency policies in their fee schedules.

Always run insurance eligibility verification before the appointment and confirm how the plan treats HPV genotyping. Commercial coverage policies, often called clinical policy bulletins, sit on each payer’s provider portal. Check the policy for the specific plan year, since large employers often modify standard plan benefits.

How claims management software reduces denials for CPT code 87625

Most HPV coding errors start at claim entry, when someone reads a lab report and picks 87624 or 87625 from memory. The mistake surfaces weeks later as a denial, and the appeal delays payment further.

In Pabau, each lab code is checked against its diagnosis code before the claim leaves the practice. Eligibility checks and Claim.MD submission run from the same patient record. A screening code on a follow-up genotype gets caught at entry, before the payer ever sees it.

The result is fewer resubmissions, faster payment and a clear record of why each HPV test was run.

Reduce claim denials on lab codes like CPT 87625

Pabau’s claims management tools help gynecology and women’s health practices check CPT and ICD-10 pairings before submission. They also track denial patterns and submit clean claims through Claim.MD.

Book a demo

Conclusion

CPT code 87625 is narrow by design. It answers one question, whether HPV 16 or 18 is present, and it usually follows a positive pooled screen. Billing teams that treat it as a follow-up code avoid most of the denials covered here.

The trade-off is documentation. A genotype claim pays when the record shows the result that prompted it and the diagnosis code says the same. Put that check at claim entry and keep Medicare screening on G0476. Book a demo to see how Pabau checks HPV code pairings before your claims go out.

Continue your research

Need to understand how clearinghouse submissions work? How a medical claims clearinghouse works explains the path from claim generation to payer adjudication.

Want to track denial patterns across your lab codes? Denial codes in medical billing covers the CARC and RARC codes you will see on your 835 remittances for HPV claims.

Looking for ERA and remittance guidance? Electronic remittance advice (ERA) explained walks through reading 835 files to identify patterns in HPV claim adjustments.

Frequently asked questions