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