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G0101 - Medicare uses G0101

  1. Question G0101 - Medicare uses G0101
    Medical Coding Books
    Medicare uses G0101 for a pap and pelvic exam. Do private insurance companies use this code? I was under the impression this was exclussive to Medicare.

  2. Default
    As far as I know this code is exclusive to Medicare...other private carriers use the 9938x or 9939x preventive EM codes

  3. Default
    Yes, the code G0101 is exclusive to medicare.

  4. #4
    Location
    Columbia, MO
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    12,531
    Default
    Quote Originally Posted by Ema Matuska View Post
    Medicare uses G0101 for a pap and pelvic exam. Do private insurance companies use this code? I was under the impression this was exclussive to Medicare.
    It is designated as a carrier discretion use. It is definitely for Medicare, however, Other carriers may elect to use the G0101 for well woman if they wish to. You need to clarify with each carrier you contract with.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Smile Cpc
    I know that I've had cases where the patient has Medicare through an HMO, and they request that the G0101 be used instead (examples: Medica, Humana Medicare, & Vista Medicare). So I've had to go back and change the 993xx to the G0101. Hope this helps...

  6. Default G0101
    G0101 does not replace 9939? or 9938?, these codes are completely seperate and have completely different meanings. G0101 is mostly representative of Medicare's billing although the 9939? or 9938? can be billed together. The 99 codes are always the part of the exam that are informational (Hi Ms. Jones, anything new? did you follow-up with your---?, Any new meds? Any new issues since the last time we seen you?) The G0101 is strictly the pelvic and breast exam and Q0091 is for the pap smear collection. So when billing commerical carriers the 99 codes should be used. When billing Medicare you should use the 99 codes if the patient doesn't have a pelvic and breast exam. If the patient has 99 codes you can also use the G code and or a Q. 9939? or 9938? are never covered by medicare, G & Q codes are covered once q 2 years or if she fits into the high risk catagory. Make sure the have an ABN signed for frequency and use the correct modifiers to show the patient was educated on the Medicare guidelines.

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