Cervical Cancer Screening

by  Find-A-Code™
Jan 1st, 2019 - Reviewed/Updated May 7th

Cervical cancer screening is preventive testing used to detect precancerous changes or early cancer of the cervix before symptoms develop. The service portion is generally reported with a combination of a screening exam code, a specimen collection code (when applicable), and a cytopathology/HPV lab code. The diagnosis portion is reported with the applicable Z-code screening diagnosis. The correct combination of codes depends on the payer (Medicare vs commercial), risk level, and the testing performed.

Cervical cancer screenings may be performed in addition to the pelvic exam.

Procedure Codes

The following codes are used to report to Medicare instead of a preventive E/M when the patient encounter is just the screening:

G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast exam (must document at least 7 of 11 required elements per NCD 210.2)
Q0091 – Obtaining, preparing, and conveying a screening Pap specimen to the lab (clinician/collection side)

Commercial / non-Medicare Procedure Codes

The following codes may be reported when the payer does NOT follow Medicare guidelines:

Visit: 99381–99397 Preventive E/M visit codes typically capture the pelvic/breast exam — do not bill G0101 when using these E/M codes.

Lab: 88141–88175 for Pap cytopathology and 87624 / 87625 for HPV high-risk by NA.

Diagnoses Codes for Cervical Cancer Screening

The following are some diagnosis codes to report this service (depending on payer preferences):

Z12.4 – Encounter for screening for malignant neoplasm of cervix (primary screening Dx)

Z11.51 – Encounter for screening for HPV (add when an HPV co-test is performed)

Z01.411 / Z01.419 – Encounter for gyn exam (general adult medical exam) with / without abnormal findings — use when the Pap is part of a routine gyn exam

Coverage — Cervical Cancer Screening

Coverage varies by payer so be sure to review payer policies. Payers typically do not cover this service for women who have had a complete (total) hysterectomy for benign disease (e.g., no evidence of cervical neoplasia or cancer) or do not have a cervix.

While most payers typically cover this service for women over 21 years of age who have not had a hysterectomy, how often (i.e., frequency) it can be performed varies. For example:

• Medicare: Covers one screening every 5 years for asymptomatic patients age 30-65
• Aetna (Policy #0443) states that they cover high risk HPV testing in the following situations:
  • Assessment of women with atypical squamous cells of undetermined significance (ASCUS) or atypical glandular cells not otherwise specified (AGC NOS).
  • Follow-up of women with ASCUS, AGC NOS, low-grade squamous intra-epithelial lesions (LSIL), or atypical squamous cells who have a previously positive HPV DNA test and/or negative colposcopy results within the past 2 years
  • In conjunction with screening Pap smears for women over age 29. However, if previous results were negative, it can only be done every 3 years.

Billing Tips

• Co-insurance and deductibles waived. Append modifier 33 to the screening procedure on commercial claims to flag the service as a USPSTF-preventive (no cost-share under ACA). Do not append to Medicare HCPCS G/Q codes.
• Place of Service (POS) typically needs to be 81 “Independent Lab” or 11 “Office”
• For Institutional claims (i.e., UB-04), use Type of Bill (TOB) codes 12X, 13X, 14X, 22X, 23X, and 85X
• Conversion to diagnostic: If the patient has signs/symptoms or an abnormal prior Pap is being followed up, do not use Z12.4; use the abnormal-finding or symptom code (e.g., R87.61-, N87.-, Z08, Z86.001) and the diagnostic CPT codes — not the screening HCPCS codes.
• CLICK HERE to review information from Medicare about these services.