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Get Paid for G0101 and Q0091 Under the AIR System

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  • December 3, 2014
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HCPCS Level II codes G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination and Q0091 Screening Papanicolaou smear have been added to the list of preventive services paid by the Centers for Medicare & Medicaid Services (CMS), based on the All-Inclusive Rate (AIR) system for rural health clinics (RHCs) and federally qualified health centers (FQHCs). G0101 and Q0091 are billable visits when furnished by a RHC or FQHC practitioner.
CR8927 instructs:

These services will be paid the AIR on RHC and FQHC claims for 71X and 77X Types of Bills (TOBs), effective for dates of service on or after January 1, 2014. Please note that deductible and coinsurance are NOT to be applied to G0101 or Q0091. If other billable visits are furnished on the same day as G0101 or Q0091, only one visit will be paid.

G0101 or Q0091 are payable annually for:

  • Women at high risk for developing cervical or vaginal cancer
  • Women of childbearing age who have had an abnormal Papanicolaou test within the past three years

G0101 or Q0091 are payable every two years for women at normal risk.
“FQHCs billing under the PPS, G0101, and Q0091 are qualifying visits when billed with FQHC payment HCPCS codes G0466 or G0467,” according to CR 8927.
Medicare will adjust any denied claims with codes G0101 or Q0091 that you bring to their attention prior to implementation on April 6, 2015.
See MLN Matters® MM8927 for more information.

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Michelle A. Dick, BS, provides writing, editorial expertise, and graphic imagery to clients. She is a freelance proofreader for Partners & Napier’s The Vine and the owner of My Garden Gal, a garden maintenance and landscaping business. Prior to becoming a free agent, Dick was an executive editor for AAPC, editor-in-chief at Eli Research, editor at Element K Journals, and ad coordinator and web designer for White Directory Publishers, Inc.

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