CPT Codes For Pap Smear, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091

(2022) CPT Codes For Pap Smear – Descriptions & Billing Guidelines

Pap smear can be billed with G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001 and Q0091. Descriptions of the codes and the billing guidelines can be found below.

G0123 CPT Code

G0123 can be billed for screening cytopathology. The screening by the cytotechnologist is under physician supervision. Collected in preservative fluid and automated thin layer preparation. The screening can be vaginal or cervical.

G0124 CPT Code

G0124 can be billed for screening cytopathology with automated thin layer preparation and requires interpretation by physician. Collected in preservative fluid and automated thin layer preparation. The screening can be vaginal or cervical.

G0141 CPT Code

G0141 can be used for screening cytopathology smears with manual rescreening and requires interpretation by physician. The screening can be vaginal or cervical or vaginal and performed by an automated system.

G0143 CPT Code

G0143 can be billed for screening cytopathology with manual screening and rescreening by cytotechnologist under physician supervision. Collected in preservative fluid and automated thin layer preparation. The screening can be vaginal or cervical.

G0144 CPT Code

G0144 can be billed for screening cytopathology with screening by an automated system under physician supervision. Collected in preservative fluid and automated thin layer preparation. The screening can be vaginal or cervical.

G0145 CPT Code

G0145 can be billed for screening cytopathology with screening by an automated system and manual rescreening under physician supervision. Collected in preservative fluid and automated thin layer preparation. The screening can be vaginal or cervical.

G0147 CPT Code

G0147 can be billed for screening cytopathology smears and needs to be performed by an automated system under physician supervision. The screening can be vaginal or cervical.

G0148 CPT Code

G0148 can be billed for screening cytopathology smears and needs to be performed by an automated system with manual rescreening. The screening can be vaginal or cervical.

P3000 CPT Code

P3000 can be billed for screening papanicolaou smear (max 3 pap smears) and needs to be performed by a technician under physician supervision. The screening can be vaginal or cervical.

P3001 CPT Code

P3001 can be billed for screening papanicolaou smear (max 3 pap smears) requires interpretation by physician. The screening can be vaginal or cervical.

Q0091 CPT Code

Q0091 can be billed for screening papanicolaou smear (pap smear) and includes;

  • preparing of cervical or vaginal smear to laboratory;
  • obtaining of cervical or vaginal smear to laboratory; and
  • conveyance of cervical or vaginal smear to laboratory.

Read more about billing guidelines for Q0091 here.

Billing Guidelines For Pap Smear

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).

Reimbursement

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/smear for all female beneficiaries when a physician (or authorized practitioner) orders the test.

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.

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

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).

Medicare Part B covers an annual screening Pap smear (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.

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