Highmark Medical Policy Bulletin
Section: Visits
Number: V-35
Topic: Annual Gynecological Examinations and Routine Pap Smears
Effective Date: August 28, 2000
Issued Date: August 28, 2000
Date Last Reviewed:

General Policy Guidelines

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 (code S0610 or S0612).

Note:
See Medical Policy Bulletin L-1 for additional information regarding pap smears.

Procedure Codes

S0610S0612G0123G0124G0143G0144
G0145P3000P3001992019920299203
992049920599211992129921399214
992159938199382993839938499385
993869938799391993929939399394
993959939699397   

Traditional (UCR/Fee Schedule) Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

Comprehensive/Wraparound/PPO Guidelines

Refer to General Policy Guidelines

Managed Care (HMO/POS) Guidelines

Refer to General Policy Guidelines

Publications

PRN References

04/1995, Annual gynecological exams and routine pap smears, reporting of,

References

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Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.