Screening Pelvic Examinations


G0101 - Cervical or vaginal cancer screening; pelvic and clinical breast examination


  • 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


All female Medicare beneficiaries

Pelvic exam and Pap test can be performed during same encounter

Exam Requirements

Must include seven (7) of the 11:

  1. Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge
  2. Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses

Pelvic examination (with or without specimen collection for smears and cultures) including:

  1. External genitalia (for example, general appearance, hair distribution, or lesions)
  2. Urethral meatus (for example, size, location, lesions, or prolapse).
  3. Urethra (for example, masses, tenderness, or scarring)
  4. Bladder (for example, fullness, masses, or tenderness)
  5. Vagina (for example, general appearance, estrogen effect, discharge lesions, pelvic support, cystocele, or rectocele)
  6. Cervix (for example, general appearance, lesions, or discharge)
  7. Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support)
  8. Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity)
  9. Anus and perineum

Diagnosis Code

High Risk

  • Z72.51 - High risk heterosexual behavior
  • Z72.52 - High risk homosexual behavior
  • Z72.53 - High risk bisexual behavior
  • Z77.29 - Contact with and (suspected) exposure to other hazardous substances
  • 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


Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0101


Last Updated Mar 20 , 2024