Medicare Screening Pap Calls for Q0091

Reporting physician services for collection of a Papanicolaou (Pap) smear is complicated due to varying payer guidelines, and depends on whether the test is for screening or diagnostic purposes.

When coding for Medicare patients, collection only of a screening Pap smear is reported using Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory. Medicare will pay for one screening every two years for low risk beneficiaries, or once per year for beneficiaries at high risk for cervical or vaginal cancer, or for woman who are of childbearing age and have had an abnormal Pap test in the past 36 months.

Complete instructions (including the full definition of “high risk” and applicable diagnosis codes) may be found in the Medicare Claims Processing Manual, chapter 18, sections 30.2-30.9.

A few private (non-Medicare) payers will accept Q0091 for collection only of a screening Pap smear. If the payer does request Q0091, ask for the policy in writing.

If the physician collects only a diagnostic Pap smear (i.e., the Pap smear is collected due to illness or other signs/symptoms supporting medical necessity) for a Medicare or private-pay patient, the physician’s effort is an included component of any evaluation and management (E/M) service provided, and may not be reported separately, per the American Congress of Obstetricians and Gynecologists (ACOG).

Generally, reimbursement for obtaining a Pap smear is factored into the relevant lab procedure code, although some private payers may allow you to report 99000 Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory for the handling and/or conveyance of a specimen for transfer from a physician’s office to a laboratory (check with your payers for guidelines).

Relevant CPT® codes to report lab services for Pap smears include 88142-88175. Applicable HCPCS Level II codes for lab services include G0123, G0143-G0148, and P3000.

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2 Responses to “Medicare Screening Pap Calls for Q0091”

  1. Lynda says:

    The AMA in CPT Assistant Feb. 1999 noted, 99000 “is intended to be reported when the physician incurs costs to handle and/or transport a specimen to the laboratory (e.g., via messenger service). If the specimen is picked up by laboratory staff at no additional cost to the physician, it would not be appropriate to report CPT code 99000.”

  2. Barnali says:

    Thank you .This is very useful article

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