Preventive Services

Preventive Services Guide


Screening Pap Tests

Cervical cytology, also called a Pap test, looks for abnormal changes in cells in the cervix, which is part of a woman’s reproductive organs. Screening for cervical cancer via a Pap test is very effective and has greatly reduced the number of cervical cancer deaths.

Coverage Criteria

Covered every 24 months for asymptomatic non-high-risk female patients.

Covered every 12 months when the following criteria is met:

  • Evidence of high risk or other specified personal history presenting hazards to health
  • Examination indicated cervical/vaginal cancer or other abnormality during any of preceding three years for women of childbearing age

Cervical/vaginal cancer high-risk factors include the following:

  • Early onset of sexual activity (aged 16 and younger)
  • Multiple sexual partners (five + in lifetime)
  • History of a sexually transmitted disease
    • Includes HPV and/or HIV infection
  • Fewer than three negative Pap tests of no Pap test within previous seven years
  • Diethylstilbestrol (DES) exposed daughters of women who took DES during pregnancy

HCPCS/CPT Coding

  • G0476: Infectious agent detection by nucleic acid (DNA or RNA); high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to Pap test

HCPCS/CPT Coding Pap Test Procedure

  • G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
  • G0143: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
  • G0144: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system under physician supervision
  • G0145: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
  • G0147: Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
  • G0148: Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
  • P3000: Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision

HCPCS/CPT Codes Physician Interpretation Procedure

  • G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
  • G0141: Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
  • P3001: Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician

HCPCS/CPT Codes Sent to Laboratory Procedure

  • Q0091: Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

Diagnosis Coding

  • ICD-10 Codes
    • High risk – Z72.51, Z72.52, Z72.53, Z77.29, Z77.9, Z91.89 and Z92.89
    • Low risk – Z01.411, Z01.419, Z12.4, Z12.72, Z12.79 and Z12.89

Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service, and contact your MAC for guidance.

Who Can Perform?

  • Must be ordered and collected by DM, DO or other qualified NPP
  • Must be authorized under state law to perform
  • Qualified NPPs including certified nurse midwife, physician assistant, nurse practitioner, and clinical nurse specialist

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

Reimbursement

Paid under different fee schedules depending on the service rendered

Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

Billing Tips

  • Covered E/M visit can be billed on the same day as Q0091
    • Report modifier 25 on the E/M service
    • Clearly document in the medical record medical necessity of separately identifiable E/M service
  • Screening for cervical cancer with HPV testing is covered every five years for asymptomatic female patients age 30–65 years in conjunction with Pap smear
  • Screening pelvic examination and screening pap test can be performed during the same encounter
    • Enter both procedure codes on separate line items of the claim

Common Claim Denials

  • Patient not at high risk and received covered screening within past two years
  • High risk patient received covered screening within past year

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Reviewed 9/27/2024