Speaking from experience, be aware that if Clinical Labs sends the HPV test to a different lab location than the Pap smear, and if each location bills Medicare separately for each test, Medicare will pay for the Pap smear but may deny the HPV test as “routine” and not covered.
Full Answer
What is an HPV/PAP cotest?
If you’re at high risk for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months. Part B also covers Human Papillomavirus (HPV) tests (as part of a Pap test) once every 5 years if you’re age 30-65 without HPV symptoms.
What does Medicare Part B cover for HPV?
Feb 22, 2016 · February 9, 2018 at 5:14 pm. Speaking from experience, be aware that if Clinical Labs sends the HPV test to a different lab location than the Pap smear, and if each location bills Medicare separately for each test , Medicare will pay for the Pap smear but may deny the HPV test as “routine” and not covered.
Does Medicare Advantage cover Pap smear tests?
Sep 10, 2018 · Does Medicare Cover Pap Smears? Last Updated : 09/10/2018 4 min read. According to the American Cancer Society, women age 21 to 29 should have a Pap smear test to screen for cervical cancer every three years. Women age 30 to age 65 should have a Pap smear test combined with an HPV test every five years.
Can abnormal Pap test results lead to cervical cancer?
You can perform a screening Pap test and a screening pelvic exam during the same patient encounter. You can also perform an HPV screening during the same encounter on any asymptomatic female patients aged 30–65 at the same time you provide a Pap test. When this happens, report both HCPCS procedure codes as separate line items on the claim.
Is HPV test covered by Medicare?
If you're age 30–65 without Human Papillomavirus (HPV) symptoms, Medicare covers HPV tests (as part of a Pap test) tests once every 5 years.Jan 12, 2021
Why does Medicare not cover Pap smears?
Pap tests are considered a preventative service under Medicare Part B, so you won't pay a coinsurance, copayment or Part B deductible for this test.
Does Medicare cover G0476?
Retroactive to date of service July 9, 2015, screening for HPV is now covered when performed in conjunction with a cervical cancer screening under the following conditions: Once every 5 years for asymptomatic beneficiaries aged 30 – 65 years. G0476 has been created for reporting this test to Medicare.
Why is HPV testing not recommended?
Why is cervical cancer screening not recommended before age 21? Cervical cancer is extremely rare in this age group. Fewer than 1 in 1,000 cases of cervical cancer occur in young women 15 to 19. Most women become infected with HPV shortly after they begin having vaginal intercourse.
Does Medicare pay for annual Pap smears?
Does Medicare Cover an Annual Pap Smear? Medicare Part B covers a Pap smear once every 24 months. The test may be covered once every 12 months for women at high risk. Your doctor will usually do a pelvic exam and a breast exam at the same time.
How does Medicare code for Pap smear?
Bottom line: Use Q0091 when obtaining a screening Pap smear for a Medicare patient. But also check with your private payers to see if they allow it in connection with a preventive medicine service.Feb 27, 2019
Is a colposcopy covered by Medicare?
Medicare covers these screening tests once every 24 months in most cases. If you're at high risk for cervical or vaginal cancer, or if you're of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months.
What is CPT code G0476?
HCPCS code G0476 for Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test as maintained by CMS falls under Other Services .
What is the CPT code for Pap smear with HPV?
Test Details Pap results requiring physician interpretation will be performed at an additional charge (CPT code(s): 88141; HCPCS: G0124).
Why are Pap smears not recommended after 65?
Most women are exposed to HPV in the course of normal sexual activity if they've had more than one sexual partner. The reason we don't do Pap tests before age 21 is because the likelihood of someone that young getting cervical cancer is very low. After age 65, the likelihood of having an abnormal Pap test also is low.
Can HPV testing replace the Pap smear?
HPV Testing Alone Can Replace Pap Smear For Women Over 30 : Shots - Health News HPV testing is now seen as equally effective as Pap tests for cervical cancer screening. An influential federal advisory group has changed guidelines for how women over 30 should get tested.Aug 21, 2018
Are Pap test and HPV test the same?
The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.
Does Medicare Coverage Pay For A Pap Smear?
Original Medicare provides your health-care coverage in two parts: Medicare Part A provides hospital coverage for inpatient hospital and skilled nu...
What Are My Costs For A Pap Smear Test Under Medicare Coverage?
When you schedule an appointment for a Pap smear, your doctor may also schedule you to receive a pelvic and breast exam, so that he or she can scre...
For More Information on Prevention of Cervical Cancer, See
Centers for Disease Control and Prevention, “What are the risk factors for cervical cancer?” last updated May 6, 2014.Centers for Disease Control a...
Conditions for Coverage
CMS will cover screening for cervical cancer with HPV testing once every 5 years as a preventive service benefit under Medicare for asymptotic patients age 30 to 65 years old, with a Pap smear.
Coding Claims
CMS has created a new code to report this service: Effective July 9, 2015, labs (place of service 81 Independent laboratory or 11 Office) may report HCPCS Level II G0476 HPV combo assay, CA screen.#N#This code will be priced by Medicare administrative contractors for claims with dates of service between July 9, 2015 to December 31, 2016.
What is the purpose of a Pap smear?
The primary goal of a Pap smear test is to screen for signs of cervical cancer. During the Pap smear test, your doctor uses a small spatula-shaped device to scrape a few cells from your cervix. The doctor then sends the cells to a laboratory to check for “pre-cancers” or cell abnormalities that can cause cervical cancer.
What is the difference between Medicare Advantage and Medicare Advantage?
The primary difference with Medicare Advantage is that you get Medicare benefits from a Medicare-approved private insurance company instead of directly through the government. Some Medicare Advantage plans include extra benefits such as prescription drug coverage.
Does Medicare cover Pap smears?
Medicare Part B covers Pap smears and pelvic exams to screen for cervical and vaginal cancer. In addition, part of this screening includes a clinical breast exam to screen for breast cancer. All women with Medicare Part B are covered for these three screenings once every 24 months.
Is CPT copyrighted?
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
Does Medicare cover Pap?
Medicare Part B covers screening Pap tests and pelvic exams (including clinical breast exam) for all female patients when ordered and performed by 1 of these medical professionals, as authorized under state law:
What is the code for HPV?
Also when you code an HPV positive for screening it should be V73.81, 079.4 or if it is diagnostic you use whatever the code was assigned for the reason for the HPV to be done. So if it was LGSIL or ASUS or malignant neoplasm you will use whatever diagnosis code the physician ordered it to assign that diagnosis code.
What is the code for HPV positive cells?
The code 795.05 is for HPV positive only. You can be HPV positive and still have "normal" cells. I would code ASCUS as 795.01. Also look at 795.02 to 795.04 for low grade to high grade abnormalities. I think the problem is specificity.
What is true blue?
True Blue. So what you have is a patient with an abnormal PAP and now being tested for HPV. A lab cannot be coded for the result until the provider reviews it an renders the dx. Therefore use the 795.01 since that is what is known and is the reason for the test.
What is a Pap smear?
A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. For an HPV/Pap cotest, an HPV test and a Pap test are done together.
Can cervical cancer cause anxiety?
There are a few risks that come with cervical cancer screening tests. Screening tests and follow-up tests can cause physical discomfort. There’s also the possibility of added anxiety and other emotions from incorrect, or false-positive, test results.
Is cervical cancer screening effective?
Credit: iStock. Routine cervical cancer screening is very effective for preventing cervical cancer and deaths from the disease.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
Article Guidance
It has come to our attention that services submitted for screening for cervical cancer with Human Papillomavirus (HPV) Testing have been reported incorrectly. This Billing and Coding Article provides billing and coding guidance for these services.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is a Pap test?
A Pap test is a simple and quick screening test conducted to obtain a smear of vaginal or cervical cells for cytological study. The human papillomavirus (HPV) test and the Pap test examine cells from a woman’s cervix. The Pap test looks at the cells to see if they are cancerous.
What is the code for papanicolaou smear?
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory. Using HCPCS code Q0091: Q0091 should be used when obtaining a screening Pap smear for a Medicare patient, though private payers may allow it along with a preventive medicine service (AAFP).
What is the code for a pelvic exam?
For a screening clinical breast and pelvic exam, Medicare patients can be billed using code G0101, “Cervical or vaginal cancer screening; pelvic and clinical breast examination.”. Knowing the codes as well as Medicare and private payer rules is crucial to get reimbursed for administering Pap smears.
