September 1st, 2017
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Screening Pelvic Examinations (includes a clinical breast examination):
|G0101 -||Cervical or vaginal cancer screening; pelvic and clinical breast examination|
Current codes are listed in the ICD-10 Conversion/Coding Infrastructure Revisions to National Coverage Determinations (NCDs)--3rd Maintenance CR9252. The Medicare Claims Processing Manual, Chapter 18, Section 40.4 is pending an update to correct this information.
Who Is Covered
All female Medicare beneficiaries
- Annually if at high risk for developing cervical or vaginal cancer or childbearing age with abnormal Pap test within past 3 years
- Every 2 years for women at normal risk
Medicare Beneficiary Pays
- Copayment/coinsurance waived
- Deductible waived
Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.
Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.