Screening Pap Tests

HCPCS/CPT Codes

  • G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148 - Screening cytopathology, cervical or vaginal
  • P3000 - Screening Pap smear by technician under physician supervision
  • P3001 - Screening Pap smear requiring interpretation by physician
  • Q0091 - Screening Pap smear; obtaining, preparing and conveyance to lab

Frequency

  • Annually if at high risk for developing cervical or vaginal cancer or childbearing age with abnormal Pap test within past three years
    • High risk factors:
      • Early onset of sexual activity
      • Multiple sexual partners
      • History of sexually transmitted disease
      • Fewer than three negative or any pap smears within previous seven years
      • DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy
  • Every two years for women at normal risk

Diagnosis Code

High Risk

  • Z72.51 - High risk heterosexual behavior
  • Z72.52 - High risk homosexual behavior
  • Z72.53 - High risk bisexual behavior
  • Z77.21 - Contact with and (suspected) exposure to potentially hazardous body fluids
  • Z77.22 - Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
  • Z77.9 - Contact with and (suspected) exposures hazardous to health
  • Z91.89 - Other specified personal risk factors, not elsewhere classified
  • Z92.89 - Personal history of other medical treatment

Low Risk

  • Z01.411 - Encounter for gynecological examination (general) (routine) with abnormal findings
  • Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings
  • Z12.4 - Encounter for screening for malignant neoplasm of cervix
  • Z12.72 - Encounter for screening for malignant neoplasm of vagina
  • Z12.79 - Encounter for screening for malignant neoplasm of other genitourinary organs
  • Z12.89 - Encounter for screening for malignant neoplasm of other sites

Coverage

  • All female Medicare beneficiaries
    • Pap test and pelvic exam can be performed during same encounter
  • Ordered by Physician, Certified Nurse Midwife (CNM), PA, NP, CNS

Pap test and Pelvic exam can be performed during same encounter

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0123, G0143, G0144, G0145, G0147, G0148, P3000 and Q0091

Resources

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