I do Ob/gyn coding and from my notes it says Q0091 is billed for doing the screening pap smear and G0101 is billed for the pelvic exam and breast check. So if both were done, you use both Q0091 and G0101 for medicare patients and you need to use diagnosis V76.2. Medicare will pay for this every two years and if the patient meets Medicare's criteria for high-risk, the exam is reimbursed every year.
Medicare preventive coverage includes a pelvic examination & breast check (G0101) and collection of Pap smear speciment (Q0091). It does not include other services normally included in a preventive exam, such as taking vital signs, examining skin, heart, lungs, and reviewing systems, past family and social history.
If more than one preventive service is provided during the same encounter, a physician should submit the screening codes to Medicare for payment (G0101/Q0091) and the preventive code 99285 etc to the patient for payment. The amount reimbursed by Medicare for the covered screening services is deducted from the amount billed to the patient for the other preventive services.
Example: annual gyn exam. Medicare covered the pap smear, pelvic exam & breast check. Doctor charges $120 for an annual exam. Dr. bills Medicare $33.68 Pelvic & breast exam and $50.58 collection of pap smear, and bills cpt 99385-52 (Preventive Med new pt) $35.74 to the patient and the Total is $120.00.
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