pap smears - medicare code


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I have been getting mixed ideas about pap smear with a physical. Does anyone know if you are allowed to bill the medicare code Q0091 pap smear obtaining with a female physical, some insurances pay it some don't or does anyone use a different code. I am understanding it that a pap is bundled in the physical but some insurance are paying the Q code. Any help would be appreciated, thanks.
It is my understanding Medicare pays Level II codes but because of what is called "carrier discretion", not all insurers pay HCPCS codes. I always code to the highest specificity as the documentation supports. The Q codes in HCPCS are in the temporary code section.

In CPT Cytopathology chapter, the instructions state to use the screening code which best describes the screening method and use an additional code for the preparation, screening, and interpretation. Examples: 88141 and 88164. I don't have the CPT Assistant to refer to but the CPT book refers to several editions which may help you answer your questions. Good Luck.
I do billing for a gyn and we do bill the Q0091 with physicals, medicare will not pay the G code as it it included with your preventative care but they do allow the Q code.