Objective: To evaluate adherence to the 2012 ASCCP guidelines by physicians referring patients to a large academic center for a colposcopy and to understand the factors associated with incorrect referrals. Design: A retrospective observational study Setting: A large tertiary referral hospital Population: Woman referred to Virginia Commonwealth University for colposcopy or loop electrosurgical excision procedure from January 2015 to December 2016. Methods: Data on patient demographics, cervical cytology, human papillomavirus status, and the recommended interventions were gathered. Main Outcome Measures: Concordance with ASCCP guidelines Results: Referral requests for 430 women were reviewed. Of the referrals, 17.4% were discordant with the ASCCP guidelines. The most common discordant colposcopy referrals were for low-grade squamous intraepithelial (LSIL) lesion (48%) and atypical squamous cell of undetermined significance (29%). The likelihood of incorrect referral was decreased for high grade lesions (OR 0.03), increased in women age < 25 (OR 31.6) and those referred by family medicine (OR 3.6) or internal medicine (OR 4.4). Ten patients were referred for cervical cytology collected on vaginal cuffs despite hysterectomies performed for benign reasons. Conclusions: Patients referred outside of the guidelines were most often women age < 25 with low-grade lesions. Referrals outside of evidence-based guidelines may lead to unnecessary procedures and added healthcare expense. Our results help identify areas for provider education and potential areas for concern in the implementation of the 2019 ASCCP updates.