Effective for services performed on or after June 20, 1994, payment will be made for one (1) annual gynecological examination (S0610 or S0612) regardless of the patient's condition, and one (1) routine pap smear (G0123, G0124, G0143-G0145, P3000, P3001) per calendar year for all females. A gynecological exam (code S0610 or S0612) may include, but is not limited to, the following services: history, blood pressure and/or weight checks, physical examination of pelvis/genitalia, rectum, thyroid, breasts, axillae, abdomen, lymph nodes, heart and lungs. When a physician performs a systemic physical examination which includes an annual gynecological examination, the appropriate evaluation and management code (99201-99215, 99381-99397) may be reported in addition to the annual gynecological examination (S0610 or S0612). Obtaining the specimen, preparing the slide, and conveyance of a pap smear (Q0091) is considered to be an integral part of the gynecological examination (S0610, or S0612) or evaluation and management service (99201-99215, 99381-99397). It is not eligible as a distinct and separate service. Therefore, any payment for the gynecological exam or evaluation and management service on the same date of service includes the allowance for this procedure. A participating, preferred, or network provider cannot bill the patient separately for this service in this case. Charges for obtaining the specimen, preparing the slide, and conveyance of the pap smear (Q0091) when reported independently of the gynecological examination, or evaluation and management service, are not eligible for payment. A participating, preferred, or network provider cannot bill the patient for the denied service.
- NOTE:
- See Medical Policy Bulletin L-1 for additional information regarding pap smears.
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