Screening Pap Tests - JE Part A

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

• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.4
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 30
• CMS Medicare Preventive Services
• CMS National Coverage Determination (NCD) 210.2
• CMS Screening Pap Tests and Pelvic Examinations