Medicare Pap

cmac

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Does anyone know if you can bill anything other than Q0091 to Medicare for their pap? Normally we bill a wellness based on age however i was told by our previous billing company not to bill 99397 for 65 and older to medicare and i found that to be true from denials. It seems there must be something else you can bill other than Q0091 for a pap to Medicare. I know you can bill an E/M if something separate was done which is most of the time but there are cases where we only do the pap. Anyone have any ideas?
 

Lisa Bledsoe

True Blue
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You can bill Medicare for 99397 - it will just be denied as not a benefit and be the patient responsibility. Basically, what you need to do is code Q0091 for obtaining the pap, G0101 for breast and pelvic exam. You carve the fees for those codes out of the 99397 and only bill the patient the difference. You can find this information on your local carrier site, MedLearn Matters and CMS.
 
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