CPT code q0091 - Pap smear specimen

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

No comments:

Top Medicare billing tips