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Thread: Screening Pelvic and Breast Exam

  1. #1

    Default Screening Pelvic and Breast Exam

    AAPC: Back to School
    On a Medicare screening pelvic and breast exam (G0101), is it a requirement to perform the breast exam or can the exam include at least 7 of the 11 elements without examination of the breast? Thank you!

  2. #2


    CMS states that a breast exam is no longer required in order to report G0101, however you still must perform at least 7 of the required 11 elements below in order to report G0101:

    • Inspection and palpation of breasts for masses or lumps, tenderness, symmetry or nipple discharge

    • Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses

    • External genitalia (for example, general appearance, hair distribution or lesions)

    • Urethral meatus (such as size, location, lesions, or prolapse)

    • Urethra (for instance, masses, tenderness or scarring)

    • Bladder (for example, fullness, masses or tenderness)

    • Vagina (e.g., general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele or rectocele)

    • Cervix (for example, general appearance, lesions or discharge)

    • Uterus (such as size, contour, position, mobility, tenderness, consistency, descent or support)

    • Adnexa/parametria (for instance, masses, tenderness, organomegaly or nodularity)

    • Anus and perineum.
    adrianne, cpc

  3. #3


    Thank you for the response! This has been my understanding also, however, our auditor pointed out in the the Guide to Medicare Preventive Services July 2009 the following statement: 'the pelvic examination includes a clinical breast examination, which aids in helping to detect and find breast cancer or other abnormalties.' Any ideas?? Thanks!

  4. #4


    Ask for them to specify what they mean by that and show them CMS' statements.
    adrianne, cpc

  5. #5

    Default Screening Pelvic and Breast Exam

    We are being instructed that the breast exam is a required element, but I'm curious to see how others feel. I still feel it isn't required and is optional to be one of the 7 of 11 elements.

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