CMS Pub. 100-04, ch. 18, § 40

Section 4102 of the BBA of 1997 (P.L. 105-33) amended §1861(nn) of the Act (42 USC

1395X(nn)) to include Medicare Part B coverage of screening pelvic examinations (including a

clinical breast examination) for all female beneficiaries for services provided January 1, 1998 and

later. Effective July 1, 2001, the Consolidated Appropriations Act of 2001 (P.L. 106-554) modifies

§1861(nn) to provide Medicare Part B coverage for biennial screening pelvic examinations. A

screening pelvic examination with or without specimen collection for smears and cultures, should

include 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.