Screening Pelvic Examinations

Screening Pelvic Examinations - Includes a clinical breast examination

HCPCS/CPT Codes

• G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast examination

Covered ICD Codes for CPT G0101

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

High risk 

• Z72.51 - High risk heterosexual behavior
• Z72.52 - High risk homosexual behavior
• Z72.53 - High risk bisexual behavior
• Z72.89 - Other problems related to lifestyle
• Z77.22 - Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
• Z77.9 - Other contact with and (suspected) exposures hazardous to health
• Z91.89 - Other specified personal risk factors, not elsewhere classified

Low risk

• Z01.411- Encounter for gynecological examination (general) (routine) with abnormal findings
• Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings
• Z12.4 - Encounter for screening for malignant neoplasm of cervix
• Z12.72 - Encounter for screening for malignant neoplasm of vagina
• Z12.79 - Encounter for screening for malignant neoplasm of other genitourinary organs
• Z12.89 - Encounter for screening for malignant neoplasm of other sites

Who Is Covered

• All female Medicare beneficiaries

Frequency

• Annually if at high risk for developing cervical or vaginal cancer or childbearing age with abnormal Pap test within past 3 years
• Every 2 years for women at normal risk

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived