Cervical Cancer

Cervical cancer is the fourth most frequent cancer in women globally, according to the World Health Organization . In the United States, approximately 13,000 new cases of cervical cancer are diagnosed and about 4,000 women die from this cancer annually.1

Providers can help female patients lower their risk of cervical cancer by recommending — and administering — vaccinations and appropriate screenings.


The human papilloma virus (HPV) has been identified as a major cause of cervical cancer. The HPV vaccination can help protect women from multiple types of HPV infection.

The HPV vaccination is routinely recommended for preteens ages 11–12 (can start at age 9). Expanded guidelines for the HPV vaccine now include high-risk adults who are 27–45 years of age.

Appropriate Screenings

Cervical cancer is preventable with the HPV vaccination and regular screenings (Pap and/or HPV tests). Early detection helps in identifying cervical cancer when it is easier to treat.

The annual gynecological exam provides an excellent opportunity to discuss appropriate screenings with your patients to help them meet their individual health goals.

HEDIS® Measures

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a widely used set of healthcare performance measures for a variety of clinical procedures, including cervical cancer screenings.

The Cervical Cancer Screening (CCS) measure evaluates females, 21–64 years of age, who were screened for cervical cancer using any of the following criteria:

  • 21–64 years who had cervical cytology performed within the last three years
  • 30–64 years who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last five years
  • 30–64 years who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last five years.

HEDIS® Exclusions for the CCS Measure

  • Members who have had a total, abdominal, vaginal hysterectomy with no residual cervix, cervical agenesis, or acquired cervical absence are not required to have this screening performed.
  • Members currently in hospice and/or have received hospice services during the measurement year.
  • Members currently receiving palliative care.

NOTE: Patients who have had an abdominal or vaginal hysterectomy with no residual cervix, and no previous abnormal PAP smears may not be required to have this screening performed unless there is a recent history of cervical dysplasia or cervical cancer.


  • Exclusions – Look back as far as possible in the member’s history for exclusions.
  • Closing Gaps – Be proactive by evaluating practice processes for opportunities to close care gaps every time a patient is seen.
  • Hysterectomies – Documenting that a member had a hysterectomy does not exclude the member unless the cervix is totally removed.
  • Biopsies – Do not count biopsies as they are diagnostic and therapeutic only. These are not valid for primary cervical cancer screening.
  • Labs – Lab results that indicate the sample contained “No Endocervical Cells” may be acceptable if a valid result is reported for the test.

Documentation in the medical record must include both the following:

  • A note indicating the date the procedure was performed.
  • The result or finding.

Annual gynecological exams can be a life-saving appointment — remind your patients about their importance!

1 https://www.cdc.gov/cancer/cervical/statistics

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Highmark does not recommend particular treatments or health care services. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should determine the appropriate treatment and follow-up with your patient. Coverage of services is subject to the terms of each member’s benefit plan. Additionally, state laws and regulations governing health insurance, health plans and coverage may apply and will vary from state to state.