HPV primary screening / cervical screening

All Pinnacle practices can claim for this service. 

Note: for eligible wāhine this service MUST be free/no co-payment charged.

Funding for this service does not cover your management and administration costs. The service must be provided free to women who meet the access criteria. 

The service must meet all the Ministry of Health National Cervical Screening Programme operational policy and standards.  

To be eligible for fully funded cervical screening (regardless of whether an HPV self-test/clinician assisted test or cervical sample is taken), people must meet one of the following criteria.

• Wāhine Māori or whānau with a cervix, aged 25 – 69 years.
• Pacific women, or Pacific person with a cervix, aged 25 – 69 years.
• Community Service Card (CSC) holders, aged 25 – 69 years.
• All women and people with a cervix aged 30 years and over who are un-screened (i.e., they have never been screened for cervical cancer). This includes women and people with a cervix aged 70 to 74 years who have never been screened.
• All women and people with a cervix aged 30 years and over who are under-screened (i.e., it has been five years or more since their last cytology, OR seven years or more since their last HPV test1).
• Women and people with a cervix aged 70 to 74 years who have not had:
  • two consecutive normal cervical cytology results between 62 to 69 years, OR
  • a ‘HPV not detected’ result in the five years prior to age 70.
• Note that screening tests when patients are not due for screening are not covered by this funding. 

Note: this service must be FREE/no co-payment charged for these eligible wāhine. 

Follow-up testing is fully funded for everyone, regardless of their eligibility for fully funded routine screening. All eligible follow-up tests are listed below. 

• All recommended HPV and cytology follow-up testing after ‘HPV Other’ detected (until returned to routine screening).
• People who have not yet been returned to routine interval screening (prior to the commencement of the HPV primary screening programme on 12 September 2023) and require follow-up testing (e.g., 12 month repeat screening after a previous low-grade cytology result).
• Repeat screening after an invalid or unsuitable for analysis HPV test result, or an unsatisfactory cytology sample.
• Test of Cure (including those eligible for a Test of Cure because of historical high-grade results) or recommended follow-up after colposcopy.
• Annual co-testing (for life) because of the history of a previous HPV-negative high-grade cervical or vaginal lesion, or a history of adenocarcinoma in-situ (AIS) where the HPV status prior to treatment is unknown. 

Note that women and people with a cervix who are immune deficient are considered ‘under-screened’ when it has been 3 years or more since their last cytology, OR 5 years or more since their last HPV test. See the Clinical Practice Guidelines for Cervical Screening in Aotearoa New Zealand for further information about definitions for immune deficiency. 

People who are not listed as eligible for the service.

Note these claims are now under “HPV” not CX.

• MedTech Evolution claim via advanced form.
• Indici claim via service eligibility. 
• Profile and MyPractice claim using manual form.

Note for MedTech Evolution practices

MedTech Evolution still has old and new claim types which is causing confusion. Unfortunately we are not able to remove these but a request has been sent to Medtech to remove the old claims.

Until this happens, please remember the following service names should be IGNORED when claiming, even if they still appear in your drop-down options:

• HPV under-screened
• HPV un-screened
• Cx under-screened
• Cx un-screened.

Instead, please choose from the 6 current HPV services:

1. HPV Standard – HPVST
2. HPV Follow Up – HPVF
3. HPV Under screen Maori/Pacific – HPVUM
4. HPV Under screen non-Maori/Pacific – HPVUNM
5. HPV Un screen non-Maori/Pacific – HPVNMP
6. HPV Un screen Maori/Pacific – HPVMP 

A reminder that sometimes a rejected claim might appear in your remittance advice again the following month advising is has now been “archived”.  This doesn’t mean the claim has been rejected again, it’s just confirming that it was rejected the first time, no further action/query was received, so it has now been archived.

No. This service MUST be free/no co-payment charged for these eligible wāhine.

This service is funded by Te Whatu Ora.