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Medicare Pap

  1. #1
    Default Medicare Pap
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    Our office is having trouble billing Medicare pap's. Medicare does not pay for 99397 but does pay for the G & Q codes for pelvic/breast exam and Medicare Papp. Is that all you bill is the G & Q code or is their a way to incorporate the 99397 and get paid? How is everyone else billing Medicare papps. Most times the Dr is only doing the papp, not a breast exam. Any help would be appreciated. Thanks

  2. #2
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    Our office codes G0101 and Q0091 if you do a pap smear. If any other medical issue is discussed or treated by provider, bill an E/M code with a -25 modifier also. DX for G0101 is V76.2.

    Hope this is helpful.

    Terri Freeland CMM

  3. #3
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    If the patient is in for a preventive visit and has a pap and pelvic exam also, you can bill the 99397, G0101 (if criteria met) and Q0091. You would subtract or "Carveout" the cost of the G0101 and Q0091 from 99397.
    WPS Medicare has good information on their website:
    http://www.wpsmedicare.com/part_b/bu...services.shtml

    I hope that helps!
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. #4
    Default
    Quote Originally Posted by cmac View Post
    Our office is having trouble billing Medicare pap's. Medicare does not pay for 99397 but does pay for the G & Q codes for pelvic/breast exam and Medicare Papp. Is that all you bill is the G & Q code or is their a way to incorporate the 99397 and get paid? How is everyone else billing Medicare papps. Most times the Dr is only doing the papp, not a breast exam. Any help would be appreciated. Thanks
    Is the patient in for a Well exam also, if so you would bill it out the way you mentioned and the well exam would be a patient liability since Medicare does not cover them.

    Just my 2 cents
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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