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Thread: CPT code for Pelvic Exam

  1. #1

    Default CPT code for Pelvic Exam

    I was wondering which CPT code i use to bill for a Pelvic Exam? The Medicare equivalent is G0101. I am billing for a Rural Health Clinic and i know which code to use for Medicare patients which is G0101, but is this code also used for Medicaid and insurance patients as well?

  2. #2


    In my practice we only bill the G-codes to Medicare. We usually bill an E&M for any issues the Pt may be having (Sx of menopause, vaginitis, etc..) and the G0101 for pelvic. Also if a pap was obtained we bill a Q0091 for "obtaining pap". For Medicaid & commercial insurance Pt's we bill the preventative E&M for the visit and we send our labs out so we do not bill for them, but it would be a 88142 w/ the Dx V72.31 for routine gyn exam. With Medicare I use Dx V76.2 for screening malignant neoplasms of cervix w/ the G code and the Q code.

    I hope this helps a little.

  3. #3

    Default codeshare

    I usually bill this out as just an E/M that fits the level of service done. A pelvic exam is part of the yearly preventive visit but also will be done for diagnostic reasons. If the total exam and visit would not be strictly for preventive but diagnostic then that type of visit would not be appropriate. You did not mention that a pap was or was not obtained. You can add the Q0091 for obtaining a culture with commercial ins as well as MCR and still bill out a regualar E/M for the pelvic exam.

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