Back to Preventive Services Home Page

Screening Pelvic Examinations (includes a clinical breast examination) (NCD 210.2)

HCPCS/CPT Codes


G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast examination

ICD-10-CM (ICD-9-CM) Codes


Report one of the following codes:

  • Low Risk – V72.31 (Z01.411 or Z01.419), V76.2 (Z12.4), V76.47 (Z12.72), V76.49 (Z12.89)
  • High Risk – V15.89 (Z77.9 or Z92.89)
  • High risk – Z77.22Z77.29, Z77.9 (V15.89), Z91.89, Z72.89Z92.89, Z72.51, Z72.52, and Z72.53
  • Low risk – Z01.411 (V72.31), Z01.419 (V72.31), Z12.4 (V76.2), Z12.72 (V76.47), Z12.79, and Z12.89 (V76.49)

Who Is Covered


All female Medicare beneficiaries

Frequency


  • Annually if at high risk for developing cervical or vaginal cancer, or childbearing age with abnormal Pap test within past 3 years; or
  • Aged 40 and older: Annually
  • Every 2 years for women at normal risk

Beneficiary Pays


  • Copayment/coinsurance waived
  • Deductible waived

Back to Preventive Services Home Page