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Pap Test and Pelvic Exam
1. How do you bill for a diagnostic Pap smear? (Last Reviewed: May 29, 2008)
1. How do you bill for a diagnostic Pap smear? (Last Reviewed: May 29, 2008)
Medicare must differentiate between screening and diagnostic Pap smears because there are statutory limitations on the frequency with which screening Pap smears are allowed for payment. Diagnostic Pap smears (performed because there are signs or symptoms of disease) are reported using numeric CPT codes. Screening Pap smears (performed in the absence of signs or symptoms of disease) are reported using alpha-numeric HCPCS codes. The code selection is always based on the reason the test was performed, regardless of the results of the test.
When billing for diagnostic Pap smears;
- Use the appropriate ICD-9-CM diagnosis code.
- Use the appropriate CPT procedure code. Use 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, 88164, 88165, 88166, 88167, 88174, 88175 for diagnostic Pap smears.
- The physician interpretation of a diagnostic Pap smear is reported using code 88141. Code 88141 (list separately in addition to code for technical service) can be used with either 88142 - 88154, 88164 - 88167, or 88174 - 88175.
According to Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, §190.2 - Diagnostic Pap Smears, a diagnostic Pap smear and related medically necessary services are covered under Medicare Part B when ordered by a physician under one of the following conditions:
- Previous cancer of the cervix, uterus, or vagina that has been or is presently being treated;
- Previous abnormal Pap smear;
- Any abnormal findings of the vagina, cervix, uterus, ovaries, or adnexa;
- Any significant complaint by the patient referable to the female reproductive system; or
- Any signs or symptoms that might, in the physician's judgment, reasonably be related to a gynecologic disorder.
For information on billing/coverage of a screening Pap smear, please refer to Pub. 100-04, Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services, §30, and Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, §280.4.
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Pap Test and Pelvic Exam