How To Use HCPCS G0101 & HCPCS G0102
HCPCS code G0101 & HCPCS code G0102 are used to screen vaginal and prostate cancer. The description and coding guidelines for these codes can be found below.
1. What Is HCPCS Code G0101?
In the examination described by HCPCS G0101, the provider performs a cervical or vaginal cancer screening by taking scrapping the cells from the vagina and cervix using a small brush.
They also perform a pelvic and clinical breast examination to detect any lump or abnormality.
1.1 Description
G0101 is an HCPCS code and is officially described as: “Cervical or vaginal cancer screening; pelvic and clinical breast examination.”
1.2 Procedure
In this screening examination, the provider inspects and palpates the breast of a patient, or he examines the breast by touch to identify any tenderness, lumps, or nipple discharge.
They also perform a pelvic examination that includes checking the vagina, urethral opening, urinary bladder, urethra, cervix, uterus, anus, and perineum.
Then, they screen the cervix and vagina for cancer, also known as a pap smear test.
In this G0101 test, the provider scraps cells from the uterine cervix and vagina. He then examines them under the microscope for any abnormality.
2. What Is HCPCS Code G0102?
During the G0102 procedure, a provider performs a digital rectal exam and evaluates the prostate for abnormality.
2.1 Description
G0102 is another HCPCS code and defined by the book as: “Prostate cancer screening; digital rectal examination.”
2.2 Procedure
The G0102 procedure starts with a provider performing a prostate cancer screening, performing a digital rectal examination to assess the male patient’s prostate.
To examine the prostate, the provider inserts a gloved and lubricated finger into the rectum and checks for hardness, lumps, or abnormalities.
This examination helps detect prostate cancer in its early stages. The provider typically performs this test for the first time at the age of 40 for men at risk of having prostate cancer, such as those men with a family history of cancer.
2.3 Billing Guidelines
Per Medicare guidelines, billing and payment for HCPCS code G0102 bundles into the payment for a covered evaluation and management, or E/M service, when the provider renders the two services to a patient on the same day.
3. Resources
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1801A3.pdf
http://www.aetna.com/cpb/medical/data/500_599/0521.html
https://pubmed.ncbi.nlm.nih.gov/17007656/
