Screening Pelvic Examinations (Rev. 1541, 09-23-08)

by  Jared Staheli
June 29th, 2015

Section 4102 of the BBA of 1997 (P.L. 105-33) amended §1861(nn) of the Act (42 USC 1395X(nn)) to include Medicare Part B coverage of screening pelvic examinations (including a clinical breast examination) for all female beneficiaries for services provided January 1, 1998 and later. Effective July 1, 2001, the Consolidated Appropriations Act of 2001 (P.L. 106-554) modifies §1861(nn) to provide Medicare Part B coverage for biennial screening pelvic examinations. A screening pelvic examination with or without specimen collection for smears and cultures, should include at least seven of the following eleven elements:

• Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge;

• Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses;

• External genitalia (for example, general appearance, hair distribution, or lesions);

• Urethral meatus (for example, size, location, lesions, or prolapse);

• Urethra (for example, masses, tenderness, or scarring);

• Bladder (for example, fullness, masses, or tenderness);

• Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele);

• Cervix (for example, general appearance, lesions or discharge)

• Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support);

• Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity); and

• Anus and perineum.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 18