• Medicare developed two HCPCS codes for screening services for women, without definitive frequency time limits
• Both G0101 (screening breast and pelvic exam) and Q0091 (obtaining a screening pap smear) may be billed every two years for a low-risk patient and every year for high-risk patients
• These are not comprehensive preventive medicine services
• They may be billed on the day of a covered service (wellness visit, or a separate, problem-oriented visit) or of a non-covered service (routine preventive care codes 99381-99397, considered routine by original Medicare)
• Medicare Advantage plans can set their own rules about covered preventive services
• Information about code +99459 pelvic examination is added to the end of this article

Original Medicare does not pay for annual routine physical exams – a sore spot for gynecologists, primary care providers and Medicare beneficiaries alike. They do pay for an initial Welcome to Medicare visit, an initial wellness visit and subsequent wellness visits. The wellness visits are usually done by family physicians, internists and geriatricians, and less frequently by gynecologists.

Medicare pays for annual screening pelvic and breast exams,

• if the patient is at high risk for developing cervical or vaginal cancer, or
• of childbearing age with an abnormal Pap test within the last 3 years or
• every two years for women at normal risk.

Report this service with code G0101.