CMS Pub. 100-04, ch. 18, § 30.4.1

The professional component of a screening Pap smear furnished within an RHC/FQHC by a

physician or non physician is considered an RHC/FQHC service. RHCs and FQHCs bill the A/B

MAC (A) under bill type 71X or 73X for the professional component along with revenue code

052X. See Chapter 9, for RHC and FQHC bill processing instructions.

The technical component of a screening Pap smear is outside the scope of the RHC/FQHC benefit.

If the technical component of this service is furnished within an independent RHC or freestanding

FQHC, the provider of that technical service bills the A/B MAC (B) on Form CMS-1500.

If the technical component of a screening Pap smear is furnished within a provider-based

RHC/FQHC, the provider of that service bills the A/B MAC (A) under bill type 13X, 14X, 22X,

23X, or 85X as appropriate using their outpatient provider number (not the RHC/FQHC provider

number since these services are not covered as RHC/FQHC services). The appropriate revenue

code is 311. Effective 4/1/06, type of bill 14X is for non-patient laboratory specimens.

30.5 - Screening Pap Smears: Healthcare Common Procedure Coding System

(HCPCS) Codes for Billing

(Rev. 3460, Issued: 02-05-16, Effective: 07-09-16, Implementation: 03-07-16 - for non-shared MAC edits; 07-05-16 - CWF analysis and design; 10-03-16 - CWF Coding, Testing and Implementation, MCS, and FISS Implementation; 01-03-17 - Requirement BR9434.04.8.2)

The following HCPCS codes can be used for screening Pap smear:

A. Screening Pap Smears: Codes Billed to the A/B MAC (B) and Paid Under the Medicare

Physician Fee Schedule (MPFS)

The following HCPCS codes are submitted by those providers/entities that submit claims to A/B

MACs (B). The deductible is waived for these services effective January 1, 1998, however,

coinsurance applies.

NOTE: These codes are not billed on A MAC claims except for HCPCS Q0091 which may be

submitted to A/B MACs (B). Payment for HCPCS Q0091 performed in a hospital outpatient

department is under the outpatient prospective payment system (OPPS) (see 30.5C).

• Q0091 - Screening Papanicolaou (Pap) smear, obtaining, preparing and conveyance of

cervical or vaginal smear to laboratory;

• P3001 - Screening Papanicolaou smear, cervical or vaginal, up to three smears requiring

interpretation by a physician;

• G0124 - Screening cytopathology, cervical or vaginal (any reporting system), collected in

preservative fluid, automated thin layer preparation, requiring interpretation by physician;

and

• G0141 - Screening cytopathology smears, cervical or vaginal, performed by automated

system, with manual re-screening, requiring interpretation by physician.

B. Screening Pap Smears: Codes Paid Under the Clinical Lab Fee Schedule by A/B MACs

The following codes are billed to A/B MACs (A) by providers they serve, or billed to A/B MACs

(B) by the physicians/suppliers they service. Deductible and coinsurance do not apply.

• P3000 - Screening Papanicolaou smear, cervical or vaginal, up to three smears, by a

technician under the physician supervision;

• G0123 - Screening cytopathology, cervical or vaginal (any reporting system) collected in

preservative fluid; automated thin layer preparation, screening by cytotechnologist under

physician supervision;

• G0143 - Screening cytopathology, cervical or vaginal, (any reporting system), collected in

preservative fluid, automated thin layer preparation, with manual screening and re-screening, by cytotechnologist under physician supervision;

• G0144 - Screening cytopathology, cervical or vaginal, (any reporting system), collected in

preservative fluid, automated thin layer preparation, with screening by automated system

under physician supervision;

• G0145 - Screening cytopathology, cervical or vaginal, (any reporting system), collected in

preservative fluid, automated thin layer preparation, with screening by automated system

and manual re-screening under physician supervision;

• G0147 - Screening cytopathology smears, cervical or vaginal, performed by automated

system under physician supervision; and

• G0148 - Screening cytopathology smears, cervical or vaginal, performed by automated

system with manual reevaluation.

C. Screening Pap Smears: Payment of Q0091 When Billed to A/B MACs (B)

Payment for HCPCS Q0091 in a hospital outpatient department is under OPPS. A skilled nursing

facility (SNF) is paid using the technical component of the MPFS. For a critical access hospital

(CAH), payment is on a reasonable cost basis. For rural health clinics/Federally qualified health

centers (RHC/FQHCs) payment is made under the all-inclusive rate for the professional

component. Deductible is not applicable, however, coinsurance applies.

The technical component of a screening Pap smear is outside the RHC/FQHC benefit. If the

technical component of a screening Pap smear is furnished within a provider-based RHC/FQHC,

the provider of that service bills the A MAC under type of bill (TOB) 13X, 14X, 22X, 23X, or 85X

as appropriate using their base provider number (not the RHC/FQHC provider number since these

services are not covered as RHC/FQHC services). For independent RHCs/FQHCs, the practitioner

bills the technical component to the A/B MACs (B) on Form CMS-1500 or the ANSI X12N 837 P.

Effective April 1, 2006, TOB 14X is for non-patient laboratory specimens.

D. Screening Pap Smears: Payment of HCPCS Q0091 When Billed to A/B MACs (B)

Payment for HCPCS Q0091 is paid under the MPFS. Deductible is not applicable, however the

coinsurance applies.

Effective for claims with dates of service on and after July 1, 2005, on those occasions when

physicians must perform a screening Pap smear (HCPCS Q0091) that they know will not be

covered by Medicare because the low-risk patient has already received a covered Pap smear

(HCPCS Q0091) in the past 2 years, the physician can bill HCPCS Q0091 and the claim will be

denied appropriately. The physician shall obtain an advance beneficiary notice (ABN) in these

situations as the denial will be considered a not reasonable and necessary denial. The physician

indicates on the claim that an ABN has been obtained by using the GA modifier.

Effective for claims with dates of service on or after April 1, 1999, a covered evaluation and

management (E/M) visit and HCPCS Q0091 may be reported by the same physician for the same

date of service if the E/M visit is for a separately identifiable service. In this case, the modifier “-

25” must be reported with the E/M service and the medical records must clearly document the E/M

reported. Both procedure codes should be shown as separate line items on the claim. These

services can also be performed separately on separate office visits.

E. Screening Pap Smears: CWF Editing for HCPCS Q0091

The CWF will edit for claims containing HCPCS Q0091 effective for dates of service on and after

July 1, 2005. Previously, the editing for HCPCS Q0091 had been removed from the CWF.

Medicare pays for a screening Pap smear every 2 years for low-risk patients based on the low-risk

diagnoses, see sections 30.2 and 30.6. Medicare pays for a screening Pap smear every year for a

high-risk patient based on the high-risk diagnosis, see sections 30.1 and 30.6. This criteria will be

the CWF parameters for editing HCPCS Q0091.

In those situations where unsatisfactory screening Pap smear specimens have been collected and

conveyed to clinical labs that are unable to interpret the test results, another specimen will have to

be collected. When the physician bills for this reconveyance, the physician should annotate the

claim with HCPCS Q0091 along with modifier -76, (repeat procedure by same physician).