On March 3, 2025, Ontario Health made a major change to cervical cancer screening. The Ontario Cervical Screening Program (OCSP) has transitioned from Pap tests to primary HPV (Human Papillomavirus) testing, to better identify those who are at highest risk for cervical cancer. This shift will improve early detection and reduce unnecessary testing for low-risk individuals.
For physicians, this change brings new clinical guidelines, updated processes for ordering and collecting specimens, and adjustments to OHIP billing codes. Here’s what you need to know.
Why is HPV testing replacing Pap Smears?
The primary cause of cervical cancer is high-risk HPV infection. Traditional Pap tests detect abnormal cervical cells after they have already changed, whereas HPV testing identifies the virus itself before cellular abnormalities develop. Research has shown that HPV testing is more effective in detecting pre-cancerous changes earlier and with greater accuracy than Pap tests. It also allows for longer screening intervals for individuals who test negative, reducing unnecessary repeat testing and follow-ups.
What does this mean for physicians?
With the transition to HPV testing, physicians in Ontario will need to follow new cervical screening recommendations:
Updated Screening OCSP Guidelines
- Screening will now begin at age 25 instead of 21.
- Those who test negative for HPV will have longer screening intervals, every five years instead of three.
- HPV testing will also be used in colposcopy to determine eligibility for discharge and post-discharge screening intervals.
These changes are expected to reduce unnecessary testing while ensuring high-risk individuals receive appropriate monitoring. For more detailed information on screening eligibility and guidelines click here.
- New Requisition Forms & Specimen Collection Requirements
To ensure proper processing, healthcare providers must use the updated HPV and Cytology Tests Requisition – for Cervical Screening form when ordering HPV tests for eligible patients.
Additionally, specimen collection will require the ThinPrep® system. Any samples collected using SurePath™ will be rejected. Physicians should familiarize themselves with the How to Collect a Cervical Sample guide to avoid rejections.
- Laboratory Services & Service Providers
To streamline the implementation of HPV testing, the OCSP has designated three laboratories to process all program-related HPV and cytology tests:
- LifeLabs
- Dynacare
- North Bay Regional Health Centre
These labs will handle both routine screening and colposcopy-related follow-ups. Other community labs will support the program through supply delivery and courier services. Physicians should contact these laboratories directly for questions about processing and logistics.
Billing and OHIP code updates
These changes will bring updates to OHIP billing codes and payment rules.
As of March 3, 2025, the following new tracking codes have been introduced for testing under the Ontario Cervical Screening Program (OCSP):
- L734 – Cervicovaginal cellular evaluation/Pap as part of the OCSP
- L699 – Human Papillomavirus (HPV) testing
These codes will be paid at $0, as they are used solely for tracking purposes. Additionally, effective April 3, 2025, existing laboratory codes L713 and L733 will no longer be used for the OCSP.
Updated descriptions for existing fee codes include:
Code | Description | Value |
G365 | Collection of cervical cancer screening specimen | $12.00 |
E430 | Cervical cancer screen specimen collected outside hospital | $11.95 |
G394 | Additional cervical cancer screening specimen | $12.00 |
E431 | Follow-up cervical cancer screen specimen collected outside hospital | $11.95 |
Please note that the minimum age eligibility for billing G365 and E430 has increased from 21 years old to 25 years old.
As for the G365 billing frequency, the updated guidelines are as follows:
- For G365 services provided between March 3, 2025 and March 31, 2028, G365 is limited to once per patient per 33-month period.
- For G365 services provided on or after April 1, 2028, G365 is limited to once per patient per 54-month period.
In addition, G365 and G394 cannot be billed alongside the following procedure codes by the same provider, for the same patient, on the same date of service:
- Z730 – Endocervical curettage
- Z731 – Vaginal vault cytology
- Z787 – Colposcopy with biopsy
If these codes are submitted together, one of the services will be paid at $0 with explanatory code D7 (Not allowed in addition to other procedure). If G365 or G394 was previously paid, and Z730, Z731, or Z787 is later billed, the value of the previously paid service will be deducted with explanatory code DC (Procedure paid previously not allowed in addition to this procedure).
The OHIP Schedule of Benefits for Physician Services will be revised to reflect the updated billing guidelines.
Clarification on HPV testing coverage for non-OHIP participants
Cervical screening and colposcopy-related tests for people without OHIP coverage are outside the scope of the Ontario Cervical Screening Program (OCSP). Patients with Interim Federal Health (IFH) Program coverage are not part of the OCSP (they do not receive correspondence, and their tests are covered through IFH). However, they generally have coverage for the same tests and treatments as those covered in the province where they reside.
On an interim basis, HPV testing for individuals with IFHP coverage can be ordered at no cost through LifeLabs, Dynacare, and North Bay Regional Health Centre. Physicians should continue using the same processes previously used for ordering cytology testing, ensuring they use the appropriate requisition forms for each laboratory.
Next steps for Ontario physicians
To ensure the successful implementation of HPV testing, doctors are encouraged to follow a series of key steps.
- Update patient screening schedules – Ensure patients are screened according to the new age and interval recommendations.
- Use the updated requisition forms – The new OCSP cervical screening requisition form must be used for all program-related HPV and cytology tests.
- Follow proper collection methods – Ensure specimens are collected using ThinPrep® to avoid rejection.
- Stay informed on billing changes – Monitor for Ministry updates on billing guidelines and fee code adjustments.
Comprehensive resources have been developed to help you prepare for the upcoming change and are available at ontariohealth.ca/hpvhub.
Conclusion
The shift to HPV testing for cervical cancer screening is an important step toward more effective prevention and early detection. For physicians, adapting to these changes means keeping up with new screening guidelines, using the appropriate requisitions, and following updated billing practices to ensure a smooth transition. By embracing these changes, physicians will help make cervical cancer a more preventable disease, benefiting both their practice and the health of their patients.
If you have any questions about the new Cervical Cancer Screening guidelines or need expert support with your medical billing, our team is here to help. Contact us today for personalized guidance and assistance!
