Screening Pap Smears: High Risk vs. Low Risk

Medicare Part B has different reimbursement guidelines for the screening Pap smear based on the patient’s risk factors for cervical cancer. Medicare provides coverage of a screening Pap test for all female beneficiaries when the test is ordered and collected by a doctor of medicine, osteopathy or other authorized practitioner. For Medicare purposes, ’risk’ is defined as follows:

• • Low risk
  • Covered once every 24 months/two years (at least 23 months have passed following the month in which the last covered screening Pap test was performed)
  • For low risk, submit ICD-9 codes V76.2, V76.47, V76.49 or V72.31
• • High risk
  • Covered once every 12 months/one year (at least 11 months have passed following the month that the last covered screening was performed)
  • For high risk, submit ICD-9 code V15.89

Coinsurance and Deductible

• • HCPCS code Q0091- (collection of the specimen for a screening Pap test):
  • For services provided prior to January 1, 2011: the patient does not have to meet the yearly deductible; however, the patient is responsible for the coinsurance
  • For services provided on or after January 1, 2011: neither the Part B deductible nor the coinsurance amount applies
• • HCPCS codes G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001 (screening Pap smear laboratory test): the patient is not responsible for any coinsurance and does not have to meet the yearly deductible