Pelvic exam and Pap smear payment

July 1, 2008

I have a question concerning billing for pelvic exams and pap smears. I am told they are nonbillable services and that the physicians must just increase his E&M charge to cover it.

Question: I have a question concerning billing for pelvic exams and pap smears. I am told they are nonbillable services and that the physicians must just increase his E&M charge to cover it.

Answer: Medicare covers both, with certain limitations. Frequency allowed is determined by risk. To bill Medicare, you need to use a screening diagnosis code, usually v76.2 or v76.47. The procedure is billed with HCPCS codes, described in the chart below.

Usually, other payers do consider the Pap to be part of a preventive exam - and so also part of the E&M code. There are some payers in the country that have determined they will pay separately for the collection of the Pap smear when performed at the time of a routine preventive exam. Usually they provide written instructions to bill the Q0091 as an additional code. If the payer has issued that instruction, report the code.