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CPT codes for PAP Tests


HCPCS Codes for Screening Pap Tests

G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision

G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision

G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system under physician supervision

G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision

G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision

G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening

P3000
Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision

HCPCS Codes for Physician’s Interpretation of Screening Pap Tests

G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician

G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician

P3001 Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician

HCPCS Code for Laboratory Specimen of Screening Pap Tests

Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

NOTE: In those situations where unsatisfactory screening Pap smear specimens have been collected and conveyed to clinical laboratories unable to interpret the test results, another specimen may be collected. To bill for this reconveyance, annotate the claim with HCPCS code Q0091 along with modifier -76 (repeat procedure or service by same physician or other qualified health care professional).

Diagnosis Codes for Low Risk Screening Pap Tests

V72.31 Routine gynecological examination NOTE: This diagnosis should only be used when the provider performs  a full gynecological examination.

V76.2
Special screening for malignant neoplasms, cervix

V76.47 Special screening for malignant neoplasms, other sites, vagina

V76.49 Special screening for malignant neoplasms, other sites NOTE:  Providers use this diagnosis for women without a cervix.

Diagnosis Code for High Risk Screening Pap Tests

V15.89 Other specified personal history presenting hazards to health, other

Coverage Information

The Medicare-covered screening Pap test (Pap smear) is a laboratory test that consists of a routine exfoliative cytology test (Papanicolaou test) for early detection of cervical cancer. It includes collection of a sample of cervical cells and a physician’s interpretation of the test results.

Medicare covers a screening Pap test for all female beneficiaries when a physician (or authorized practitioner) orders the test.

Risk Factors

For purposes of this benefit, high risk categories for cervical and vaginal cancer include:

Early onset of sexual activity (under 16 years of age),

Multiple sexual partners (five or more in a lifetime),

History of a sexually transmitted infection (STI) (including human immunodeficiency virus [HIV] infection),

Fewer than three negative Pap tests or no Pap tests within the previous 7 years, and

DES (diethylstilbestrol)-exposed daughters of women who took DES during pregnancy.

Frequency

Covered Once Every 24 Months

Medicare Part B covers a screening Pap test for all asymptomatic female beneficiaries every 24 months (i.e., at least 23 months after the most recent screening Pap test).

Covered Once Every 12 Months

Medicare Part B covers an annual screening Pap test (i.e., at least 11 months after the most recent screening Pap test) for female beneficiaries who meet at least one of the following criteria:

Evidence (on the basis of her medical history or other findings) that she is at high risk (high risk categories described above) for developing cervical or vaginal cancer and her physician (or authorized practitioner) recommends that she have the test more frequently than every two years,

A woman of childbearing age who has had a pap test during any of the preceding 3 years that indicated the presence of cervical or vaginal cancer or other abnormality. A “woman of childbearing age” is one who is premenopausal and has been determined by a physician or qualified practitioner to be of childbearing age based on the medical history or other findings.

When calculating frequency to determine the annual period, 11 months must elapse following the month in which the last screening Pap test took place. Follow the same procedure to calculate frequency for the 23-month period.

EXAMPLE: A beneficiary in a high risk category gets a screening Pap test in January 2012. The count starts February 2012. The beneficiary may get another screening Pap test in January 2013.

Coinsurance or Copayment and Deductible

The beneficiary pays nothing (no coinsurance or copayment and no Medicare Part B deductible) for the screening Pap test if the provider accepts assignment. Financial responsibilities may apply for the beneficiary if the provider does not accept assignment.


For more information https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Screening-Pap-Tests-Booklet-ICN907791.pdf

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