Screening Pap Tests - JF Part B
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
- High risk factors:
- 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
Last Updated Mar 20 , 2024