Medicare_Claims_Processing_Manual / Chapter_18 / 30.5

Why This Topic Matters

These instructions affect how screening Pap smear services are reported, where claims are submitted, and how payment and cost-sharing rules apply across Medicare settings. Readers working with physician, laboratory, outpatient, SNF, CAH, and RHC/FQHC billing need this guidance to understand the scope of the policy update.

Article Sections

1. A - Codes Billed to the Carrier and Paid Under the Physician Fee Schedule

   This section identifies the screening-related HCPCS codes discussed for carrier submission and physician fee schedule payment. It also distinguishes the claim-processing pathway for these services.

2. B - Codes Paid Under the Clinical Lab Fee Schedule by FI and Carriers

   This section covers screening-related HCPCS codes paid under the clinical laboratory fee schedule and notes how they are handled by fiscal intermediaries and carriers. It also addresses setting-specific payment considerations.

3. C - Billing to the Carrier

   This section discusses claim reporting when a screening service is billed with a separately identifiable evaluation and management visit. It includes related documentation and line-item claim presentation guidance.