PT ‐ 2020 Measure Value Set_Cervical Screening

Numerator Value Set Name Code Definition Code System Cervical Cytology Lab Test 88141 CPT Cervical Cytology Lab Test 88142 CPT Cervical Cytology Lab Test 88143 CPT Cervical Cytology Lab Test 88147 CPT Cervical Cytology Lab Test 88148 CPT Cervical Cytology Lab Test 88150 CPT Cervical Cytology Lab Test 88152 CPT Cervical Cytology Lab Test 88153 CPT Cervical Cytology Lab Test 88154 CPT Cervical Cytology Lab Test 88164 CPT Cervical Cytology Lab Test 88165 CPT Cervical Cytology Lab Test 88166 CPT Cervical Cytology Lab Test 88167 CPT Cervical Cytology Lab Test 88174 CPT Cervical Cytology Lab Test 88175 CPT Screening cytopathology, cervical or vaginal (any reporting system), Cervical Cytology Lab Test G0123 collected in preservative fluid, automated thin layer preparation, HCPCS screening by cytotechnologist under physician supervision (G0123) Screening cytopathology, cervical or vaginal (any reporting system), Cervical Cytology Lab Test G0124 collected in preservative fluid, automated thin layer preparation, HCPCS requiring interpretation by physician (G0124) Screening cytopathology smears, cervical or vaginal, performed by Cervical Cytology Lab Test G0141 automated system, with manual rescreening, requiring interpretation by HCPCS physician (G0141) Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with Cervical Cytology Lab Test G0143 HCPCS manual screening and rescreening by cytotechnologist under physician supervision (G0143)

Page 1 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Numerator Value Set Name Code Definition Code System Screening cytopathology, cervical or vaginal (any reporting system), Cervical Cytology Lab Test G0144 collected in preservative fluid, automated thin layer preparation, with HCPCS screening by automated system, under physician supervision (G0144) Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with Cervical Cytology Lab Test G0145 HCPCS screening by automated system and manual rescreening under physician supervision (G0145) Screening cytopathology smears, cervical or vaginal, performed by Cervical Cytology Lab Test G0147 HCPCS automated system under physician supervision (G0147) Screening cytopathology smears, cervical or vaginal, performed by Cervical Cytology Lab Test G0148 HCPCS automated system with manual rescreening (G0148) Screening papanicolaou smear, cervical or vaginal, up to three smears, by Cervical Cytology Lab Test P3000 HCPCS technician under physician supervision (P3000) Screening papanicolaou smear, cervical or vaginal, up to three smears, Cervical Cytology Lab Test P3001 HCPCS requiring interpretation by physician (P3001) Screening papanicolaou smear; obtaining, preparing and conveyance of Cervical Cytology Lab Test Q0091 HCPCS cervical or vaginal smear to laboratory (Q0091) Cervical Cytology Lab Test 10524‐7 Microscopic observation [Identifier] in by Cyto stain LOINC Cervical Cytology Lab Test 18500‐9 Microscopic observation [Identifier] in Cervix by Cyto stain.thin prep LOINC General categories [Interpretation] of Cervical or vaginal smear or Cervical Cytology Lab Test 19762‐4 LOINC scraping by Cyto stain Statement of adequacy [Interpretation] of Cervical or vaginal smear or Cervical Cytology Lab Test 19764‐0 LOINC scraping by Cyto stain Microscopic observation [Identifier] in Cervical or vaginal smear or Cervical Cytology Lab Test 19765‐7 LOINC scraping by Cyto stain Microscopic observation [Identifier] in Cervical or vaginal smear or Cervical Cytology Lab Test 19766‐5 LOINC scraping by Cyto stain Narrative Cervical Cytology Lab Test 19774‐9 Cytology study comment Cervical or vaginal smear or scraping Cyto stain LOINC Cervical Cytology Lab Test 33717‐0 Cytology Cervical or vaginal smear or scraping study LOINC

Page 2 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Numerator Value Set Name Code Definition Code System Cytology report of Cervical or vaginal smear or scraping Cyto stain.thin Cervical Cytology Lab Test 47527‐7 LOINC prep Cervical Cytology Lab Test 47528‐5 Cytology report of Cervical or vaginal smear or scraping Cyto stain LOINC

Cervical Cytology Lab Test 171149006 Screening for malignant neoplasm of cervix (procedure) SNOMED CT US Edition

Cervical Cytology Lab Test 416107004 Cervical cytology test (procedure) SNOMED CT US Edition

Cervical Cytology Lab Test 417036008 Liquid based cervical cytology screening (procedure) SNOMED CT US Edition

Cervical Cytology Lab Test 439958008 Sampling of cervix for Papanicolaou smear (procedure) SNOMED CT US Edition

Cervical Cytology Lab Test 440623000 Microscopic examination of cervical Papanicolaou smear (procedure) SNOMED CT US Edition

448651000124 Microscopic examination of cervical Papanicolaou smear and Human Cervical Cytology Lab Test SNOMED CT US Edition 104 papillomavirus deoxyribonucleic acid detection cotesting (procedure) Cervical Cytology Result or Severe dyskaryosis on cervical smear cannot exclude invasive carcinoma 168406009 SNOMED CT US Edition Finding (finding) Cervical Cytology Result or 168407000 Cannot exclude glandular neoplasia on cervical smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 168408005 Cervical smear ‐ atrophic changes (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 168410007 Cervical smear ‐ borderline changes (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 168414003 Cervical smear ‐ inflammatory change (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 168415002 Cervical smear ‐ no inflammation (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 168416001 Cervical smear ‐ severe inflammation (finding) SNOMED CT US Edition Finding

Page 3 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Numerator Value Set Name Code Definition Code System Cervical Cytology Result or 168424006 Cervical smear ‐ koilocytosis (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 250538001 Dyskaryosis on cervical smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 268543007 Cancer cervix ‐ screening done (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 269957009 Cervical smear result (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 269958004 Cervical smear ‐ negative (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 269959007 Cervical smear ‐ mild dyskaryosis (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 269960002 Cervical smear ‐ severe dyskaryosis (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 269961003 Cervical smear ‐ moderate dyskaryosis (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 269963000 Cervical smear ‐ viral inflammation unspecified (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 275805003 Viral changes on cervical smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 281101005 Smear: no abnormality detected ‐ no endocervical cells (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 309081009 Abnormal cervical smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 310841002 Cervical smear ‐ mild inflammation (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 310842009 Cervical smear ‐ moderate inflammation (finding) SNOMED CT US Edition Finding Cervical Cytology Result or Cervicovaginal cytology: Low grade squamous intraepithelial lesion 416030007 SNOMED CT US Edition Finding (finding) Cervical Cytology Result or 416032004 Cervicovaginal cytology normal or benign (finding) SNOMED CT US Edition Finding

Page 4 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Numerator Value Set Name Code Definition Code System Cervical Cytology Result or Cervicovaginal cytology: High grade squamous intraepithelial lesion or 416033009 SNOMED CT US Edition Finding carcinoma (finding) Cervical Cytology Result or 439074000 Dysplasia on cervical smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 439776006 Cervical Papanicolaou smear positive for malignant neoplasm (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 439888000 Abnormal cervical Papanicolaou smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or Atypical squamous cells of undetermined significance on cervical 441087007 SNOMED CT US Edition Finding Papanicolaou smear (finding) Cervical Cytology Result or Atypical squamous cells on cervical Papanicolaou smear cannot exclude 441088002 SNOMED CT US Edition Finding high grade squamous intraepithelial lesion (finding) Cervical Cytology Result or 441094005 Atypical endocervical cells on cervical Papanicolaou smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 441219009 Atypical glandular cells on cervical Papanicolaou smear (finding) SNOMED CT US Edition Finding Cervical Cytology Result or Abnormal cervical Papanicolaou smear with positive human 441667007 SNOMED CT US Edition Finding papillomavirus deoxyribonucleic acid test (finding) Cervical Cytology Result or 700399008 Cervical smear ‐ borderline change in squamous cells (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 700400001 Cervical smear ‐ borderline change in endocervical cells (finding) SNOMED CT US Edition Finding Cervical Cytology Result or 620510001191 Low grade squamous intraepithelial lesion on cervical Papanicolaou SNOMED CT US Edition Finding 05 smear (finding) Cervical Cytology Result or 620610001191 High grade squamous intraepithelial lesion on cervical Papanicolaou SNOMED CT US Edition Finding 07 smear (finding) Cervical Cytology Result or 987910001191 Cytological evidence of malignancy on cervical Papanicolaou smear SNOMED CT US Edition Finding 02 (finding) High Risk HPV Lab Test 87620 CPT High Risk HPV Lab Test 87621 CPT High Risk HPV Lab Test 87622 CPT High Risk HPV Lab Test 87624 CPT

Page 5 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Numerator Value Set Name Code Definition Code System High Risk HPV Lab Test 87625 CPT Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high‐risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, High Risk HPV Lab Test G0476 HCPCS 52, 56, 58, 59, 68) for screening, must be performed in addition to (G0476) Human papilloma virus 16+18+31+33+35+45+51+52+56 DNA [Presence] High Risk HPV Lab Test 21440‐3 LOINC in Cervix by Probe Human papilloma virus 16+18+31+33+35+39+45+51+52+56+58+59+68 High Risk HPV Lab Test 30167‐1 LOINC DNA [Presence] in Cervix by Probe with signal amplification Human papilloma virus High Risk HPV Lab Test 38372‐9 6+11+16+18+31+33+35+39+42+43+44+45+51+52+56+58+59+68 DNA LOINC [Presence] in Cervix by Probe with signal amplification Human papilloma virus 16 DNA [Presence] in Cervix by Probe with signal High Risk HPV Lab Test 59263‐4 LOINC amplification Human papilloma virus 18 DNA [Presence] in Cervix by Probe with signal High Risk HPV Lab Test 59264‐2 LOINC amplification Human papilloma virus High Risk HPV Lab Test 59420‐0 16+18+31+33+35+39+45+51+52+56+58+59+66+68 DNA [Presence] in LOINC Cervix by Probe with signal amplification Human papilloma virus E6+E7 mRNA [Presence] in Cervix by NAA with High Risk HPV Lab Test 69002‐4 LOINC probe detection Human papilloma virus 31+33+35+39+45+51+52+56+58+59+66+68 DNA High Risk HPV Lab Test 71431‐1 LOINC [Presence] in Cervix by NAA with probe detection Human papilloma virus 18+45 E6+E7 mRNA [Presence] in Cervix by NAA High Risk HPV Lab Test 75694‐0 LOINC with probe detection Human papilloma virus 16 and 18 and High Risk HPV Lab Test 77379‐6 LOINC 31+33+35+39+45+51+52+56+58+59+66+68 DNA [Interpretation] in Cervix Human papilloma virus 16 DNA [Presence] in Cervix by NAA with probe High Risk HPV Lab Test 77399‐4 LOINC detection

Page 6 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Numerator Value Set Name Code Definition Code System Human papilloma virus 18 DNA [Presence] in Cervix by NAA with probe High Risk HPV Lab Test 77400‐0 LOINC detection Human papilloma virus 16 and 18+45 E6+E7 mRNA [Identifier] in Cervix by High Risk HPV Lab Test 82354‐2 LOINC NAA with probe detection Human papilloma virus 16 E6+E7 mRNA [Presence] in Cervix by NAA with High Risk HPV Lab Test 82456‐5 LOINC probe detection Human papilloma virus High Risk HPV Lab Test 82675‐0 16+18+31+33+35+39+45+51+52+56+58+59+66+68 DNA [Presence] in LOINC Cervix by NAA with probe detection High Risk HPV Lab Test 35904009 Human papillomavirus deoxyribonucleic acid detection (procedure) SNOMED CT US Edition

448651000124 Microscopic examination of cervical Papanicolaou smear and Human High Risk HPV Lab Test SNOMED CT US Edition 104 papillomavirus deoxyribonucleic acid detection cotesting (procedure) High Risk HPV Test Result or 391147004 Human papillomavirus test positive (finding) SNOMED CT US Edition Finding High Risk HPV Test Result or 391148009 Human papillomavirus test negative (finding) SNOMED CT US Edition Finding High Risk HPV Test Result or Abnormal cervical Papanicolaou smear with positive human 441667007 SNOMED CT US Edition Finding papillomavirus deoxyribonucleic acid test (finding) High Risk HPV Test Result or Cytology examination positive for high risk human papillomavirus 718591004 SNOMED CT US Edition Finding (finding) High Risk HPV Test Result or Human papillomavirus deoxyribonucleic acid test positive, high risk on 720005005 SNOMED CT US Edition Finding cervical specimen (finding)

Page 7 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Exclusion Value Set Name Code Definition Code System Absence of Cervix Diagnosis Q51.5 [Q51.5] Agenesis and aplasia of cervix ICD10CM Absence of Cervix Diagnosis Z90.710 [Z90.710] Acquired absence of both cervix and ICD10CM Absence of Cervix Diagnosis Z90.712 [Z90.712] Acquired absence of cervix with remaining uterus ICD10CM Absence of Cervix Diagnosis 37687000 Congenital absence of cervix (disorder) SNOMED CT US Edition Absence of Cervix Diagnosis 248911005 Uterine cervix absent (finding) SNOMED CT US Edition Absence of Cervix Diagnosis 428078001 History of total (situation) SNOMED CT US Edition Absence of Cervix Diagnosis 429290001 History of radical hysterectomy (situation) SNOMED CT US Edition History of total hysterectomy with bilateral salpingo‐ Absence of Cervix Diagnosis 429763009 SNOMED CT US Edition (situation) Absence of Cervix Diagnosis 723171001 Acquired absence of cervix and uterus (disorder) SNOMED CT US Edition 107388910001 History of total hysterectomy without abnormal cervical Absence of Cervix Diagnosis SNOMED CT US Edition 19107 Papanicolaou smear (situation) Hysterectomy With No Residual Cervix 51925 CPT Hysterectomy With No Residual Cervix 56308 CPT Hysterectomy With No Residual Cervix 57540 CPT Hysterectomy With No Residual Cervix 57545 CPT Hysterectomy With No Residual Cervix 57550 CPT Hysterectomy With No Residual Cervix 57555 CPT Hysterectomy With No Residual Cervix 57556 CPT Hysterectomy With No Residual Cervix 58150 CPT Hysterectomy With No Residual Cervix 58152 CPT Hysterectomy With No Residual Cervix 58200 CPT Hysterectomy With No Residual Cervix 58210 CPT Hysterectomy With No Residual Cervix 58240 CPT Hysterectomy With No Residual Cervix 58260 CPT Hysterectomy With No Residual Cervix 58262 CPT Hysterectomy With No Residual Cervix 58263 CPT Hysterectomy With No Residual Cervix 58267 CPT Hysterectomy With No Residual Cervix 58270 CPT Hysterectomy With No Residual Cervix 58275 CPT Hysterectomy With No Residual Cervix 58280 CPT Hysterectomy With No Residual Cervix 58285 CPT

Page 8 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Exclusion Value Set Name Code Definition Code System Hysterectomy With No Residual Cervix 58290 CPT Hysterectomy With No Residual Cervix 58291 CPT Hysterectomy With No Residual Cervix 58292 CPT Hysterectomy With No Residual Cervix 58293 CPT Hysterectomy With No Residual Cervix 58294 CPT Hysterectomy With No Residual Cervix 58548 CPT Hysterectomy With No Residual Cervix 58550 CPT Hysterectomy With No Residual Cervix 58552 CPT Hysterectomy With No Residual Cervix 58553 CPT Hysterectomy With No Residual Cervix 58554 CPT Hysterectomy With No Residual Cervix 58570 CPT Hysterectomy With No Residual Cervix 58571 CPT Hysterectomy With No Residual Cervix 58572 CPT Hysterectomy With No Residual Cervix 58573 CPT Hysterectomy With No Residual Cervix 58575 CPT Hysterectomy With No Residual Cervix 58951 CPT Hysterectomy With No Residual Cervix 58953 CPT Hysterectomy With No Residual Cervix 58954 CPT Hysterectomy With No Residual Cervix 58956 CPT Hysterectomy With No Residual Cervix 59135 CPT Hysterectomy With No Residual Cervix 0UTC0ZZ [0UTC0ZZ] Resection of Cervix, Open Approach ICD10PCS [0UTC4ZZ] Resection of Cervix, Percutaneous Endoscopic Hysterectomy With No Residual Cervix 0UTC4ZZ ICD10PCS Approach Hysterectomy With No Residual Cervix 0UTC7ZZ [0UTC7ZZ] Resection of Cervix, Via Natural or Artificial Opening ICD10PCS [0UTC8ZZ] Resection of Cervix, Via Natural or Artificial Opening Hysterectomy With No Residual Cervix 0UTC8ZZ ICD10PCS Endoscopic Hysterectomy With No Residual Cervix 24293001 Excision of cervical stump by abdominal approach (procedure) SNOMED CT US Edition

Hysterectomy With No Residual Cervix 27950001 Total hysterectomy with unilateral removal of (procedure) SNOMED CT US Edition

Hysterectomy With No Residual Cervix 31545000 Total hysterectomy with unilateral removal of tube (procedure) SNOMED CT US Edition

Page 9 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Exclusion Value Set Name Code Definition Code System Hysterectomy With No Residual Cervix 35955002 Radical vaginal hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 41566006 Excision of cervical stump by vaginal approach (procedure) SNOMED CT US Edition

Hysterectomy With No Residual Cervix 46226009 Cervicectomy with synchronous colporrhaphy (procedure) SNOMED CT US Edition Total hysterectomy with unilateral removal of tube and ovary Hysterectomy With No Residual Cervix 59750000 SNOMED CT US Edition (procedure) Total hysterectomy with removal of both tubes and Hysterectomy With No Residual Cervix 86477000 SNOMED CT US Edition (procedure) Removal of ectopic interstitial uterine pregnancy requiring total Hysterectomy With No Residual Cervix 88144003 SNOMED CT US Edition hysterectomy (procedure) Hysterectomy With No Residual Cervix 116140006 Total hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 116142003 Radical hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 116143008 Total abdominal hysterectomy (procedure) SNOMED CT US Edition Total abdominal hysterectomy with bilateral salpingo‐ Hysterectomy With No Residual Cervix 116144002 SNOMED CT US Edition oophorectomy (procedure) Hysterectomy With No Residual Cervix 236888001 Laparoscopic total hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 236891001 Laparoscopic radical hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 287924009 Excision of cervix stump (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 307771009 Radical abdominal hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 361222003 Wertheim‐Meigs abdominal hysterectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 361223008 Wertheim operation (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 387626007 Amputation of cervix (procedure) SNOMED CT US Edition Laparoscopic total abdominal hysterectomy and bilateral Hysterectomy With No Residual Cervix 414575003 SNOMED CT US Edition salpingo‐oophorectomy (procedure) Radical amputation of cervix with bilateral total pelvic Hysterectomy With No Residual Cervix 440383008 lymphadenectomy and paraaortic biopsy SNOMED CT US Edition (procedure) Total abdominal hysterectomy and removal of vaginal cuff Hysterectomy With No Residual Cervix 446446002 SNOMED CT US Edition (procedure) Total laparoscopic excision of uterus by abdominal approach Hysterectomy With No Residual Cervix 446679008 SNOMED CT US Edition (procedure)

Page 10 of 11 November 2019 PT ‐ 2020 Measure Value Set_Cervical Cancer Screening

Exclusion Value Set Name Code Definition Code System Abdominal hysterectomy and excision of periuterine tissue Hysterectomy With No Residual Cervix 447771005 SNOMED CT US Edition (procedure) Laparoscopic total hysterectomy using robotic assistance Hysterectomy With No Residual Cervix 708877008 SNOMED CT US Edition (procedure) Laparoscopic radical hysterectomy using robotic assistance Hysterectomy With No Residual Cervix 708878003 SNOMED CT US Edition (procedure) Hysterectomy With No Residual Cervix 739671004 Total hysterectomy with left oophorectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 739672006 Total hysterectomy with right oophorectomy (procedure) SNOMED CT US Edition Total hysterectomy with left salpingo‐oophorectomy Hysterectomy With No Residual Cervix 739673001 SNOMED CT US Edition (procedure) Total hysterectomy with right salpingo‐oophorectomy Hysterectomy With No Residual Cervix 739674007 SNOMED CT US Edition (procedure) Hysterectomy With No Residual Cervix 740514001 Total hysterectomy with right (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 740515000 Total hysterectomy with left salpingectomy (procedure) SNOMED CT US Edition Hysterectomy With No Residual Cervix 767610009 Total hysterectomy via vaginal approach (procedure) SNOMED CT US Edition Total abdominal hysterectomy using intrafascial technique Hysterectomy With No Residual Cervix 767611008 SNOMED CT US Edition (procedure) Total hysterectomy via vaginal approach using intrafascial Hysterectomy With No Residual Cervix 767612001 SNOMED CT US Edition technique (procedure)

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