HCPCS Code Code Descriptor
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory NOTE: Another specimen may be collected in situations where unsatisfactory screening Pap smear specimens have been collected and conveyed to clinical laboratories that are unable to interpret the test results. To bill for this reconveyance, annotate the claim with HCPCS code Q0091 along with modifier -76 (repeat procedure or service by same physician or other qualified health care professional).
COLLECTION OF SCREENING PAP SMEAR SPECIMEN
Medicare reimburses for collection of a screening Pap smear every two years in most cases. This service is reported using HCPCS code Q0091 (Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). The patient does not have to meet her Part B deductible, but is responsible for 20% of the Medicare approved amount for the service. For the laboratory’s interpretation of the test, the patient does not need to pay a copay nor meet her deductible.
The collection is reimbursed every year if the patient meets Medicare’s criteria for high risk. Following are the only criteria that are accepted by Medicare to indicate a high risk patient:
• Woman is of childbearing age AND
o cervical or vaginal cancer is present (or was present) OR
o abnormalities were found within last 3 years OR
o is considered high risk (as described below) for developing cervical or vaginal cancer.
• Woman is not of childbearing age AND she has at least one of the following:
o High risk factors for cervical cancer:
* Onset of sexual activity under 16 years of age
* Five or more sexual partners in a lifetime
* History of sexually transmitted disease (including the human papillomavirus and/or HIV infection);
* Fewer than 3 negative Pap smears within previous 7 years
* No Pap smears at all within the previous 7 years
o High risk factor for vaginal cancer:
* She had been exposed to DES in utero
Billing and Coding Guidelines
Routine Annual Physical & Routine GYN & Pap Smear Preventive Medicine Code New Patient Code 99383 or 99384 depending on age of patient or Established Patient Code 99393 or 99394 depending on age of patient Add Modifier 51 to Visit Code AND Routine GYN & Pap Smear Q0091 Screening Papanicolaou Smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory and **G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination V20.2 Routine child health check (age 16 and under) AND V72.31 Routine gynecological examination with or without pap smear.
Routine GYN & Pap Smear Routine GYN & Pap Smear Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory and **G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination V72.31 Routine gynecological examination with or without pap smear.
V25.09 Family Planning advice
Routine Annual Physical & WWA Preventive Medicine Code New Patient Code 99384 thru 99387 depending on age of patient or Established Patient Code 99394 thru 99397 depending on age of patient Add Modifier 51 to Visit Code AND Well Women Assessment Codes HCPCS code Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory and HCPCS code G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination V70.0 Routine Medical Exam or V20.2 Routine infant or child health check (age 16 and under) AND V72.31 Routine gynecological examination with or without pap smear.
WWA Only Well Women Assessment Codes HCPCS code Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory and HCPCS code G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination V72.31 Routine gynecological examination with or without pap smear
