SCREENING PELVIC EXAM
Medicare reimburses for a screening pelvic examination every two years in most cases. This service is reported using HCPCS code G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination). If the patient meets Medicare’s criteria for high risk, the examination is reimbursed every year. These criteria are the same as the ones listed above for the collection of screening Pap smear specimen. The diagnosis codes for pap smear collection and screening pelvic exam are listed below.
Effective September 23, 2008, Medicare clarified that the clinical breast check is no longer considered a mandatory element of the screening pelvic exam. It is now one of the eleven elements that may be performed as part of the exam.
A screening pelvic examination (HCPCS code G0101) should include documentation of at least seven of the following eleven elements:
• Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge;
• Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses;
• External genitalia (for example, general appearance, hair distribution, or lesions);
• Urethral meatus (for example, size, location, lesions, or prolapse);
• Urethra (for example, masses, tenderness, or scarring);
• Bladder (for example, fullness, masses, or tenderness);
• Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele);
• Cervix (for example, general appearance, lesions or discharge)
• Uterus (for example, size, contour, position, mobility, tenderness, consistency,
descent, or support);
• Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity);and
• Anus and perineum.
HCPCS code G0101 includes only the above examination elements. It does not include many other services normally included in a comprehensive preventive visit.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
URIBEL- methenamine, sodium phosphate, monobasic, monohydrate, phenyls alicylate, methylene blue, and hyoscyamine sulfate capsule Uribel i...
procedure code and description 71250 - Ct thorax w/o dye - average fee payment - $180 - $190 71275 CTA chest (noncoronary) 71260 CT ...
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Procedure CODE and Description 93965 - Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, Doppler waveform...