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CPT for Medicare Pap Collection

  1. #1
    Ft. Myers, FL
    Default CPT for Medicare Pap Collection
    Medical Coding Books
    I work for a family practice and we have never billed for the actually collection of pap smear specimens. Our office is CLIA waived and sends the specimens to an outside lab for interpretation. I am assuming that there is a code for just the collection because Medicare states they will pay 80% of allowable for both the collection and the lab interpretations. If anyone is billing for the collection seperately from the actual physical, I would really appreciate some advice on how to do this. I know there is a HCPCS code of Q0091 for the collection, but could not locate any coverage guidelines on Medicare's website. Thanks for any help you may be able to provide!

    Noell, CPC

  2. #2
    Medicare does not cover comprehensive well-woman services, it does cover a pelvic/clinical breast exam and a screening Pap test every 2 years. These services are covered annually for women considered to be at high risk for the development of cervical or vaginal cancer

    G0101 is the HCPCS code used to report a screening pelvic/clinical breast exam

    HCPCS code Q0091 is reported for collection of the Pap smear. This is not the code that the lab uses for the interpretation of the Pap test. Rather, it represents the work done in the physician's office to collect the specimen. Q0091 applies only to collection of a screening Pap smear.

    following ICD-9 codes is used:
    - V76.2 Special screening for malignant neoplasms, cervix (patient who has an intact cervix or uterus)
    - V76.47 Special screening for malignant neoplasms, vagina
    - V76.49 Special screening for malignant neoplasms, other sites OR
    - V15.89 Other specified personal history presenting hazards to health (patient who is considered high risk according to Medicare's criteria)

    daniel, CPC

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