Important female preventive health care includes screening pap tests and pelvic exams. Medicare covers Pap smears, pelvic exams, STI and HPV screenings.
- A screening Pap test is the laboratory test used to detect early cervical cancer.
- A screening pelvic exam helps detect precancers, genital cancers, infections, STI’s, reproductive system abnormalities, and other genital/vaginal problems
Medicare Part B covers screening Pap tests and pelvic exams (including clinical breast exam) for all female patients when ordered and performed by one of these medical professionals, as authorized under state scope of practice laws.
- Doctor of Medicine or Osteopathy
- Certified Nurse-midwife
- Physician Assistant
- Nurse Practitioner
- Clinical Nurse Specialist
Medicare-Covered Screening Pap Tests, Pelvic Exams and HPV Screening
Coding and Diagnosis Information
- You can perform a screening Pap test and a screening pelvic exam during the same patient encounter. You can also perform an HPV screening during the same encounter on any asymptomatic female patients aged 30-65 at the same time you provide a Pap test. When this happens, report both HCPCS procedure codes as separate items on the claim.
HCPCS Codes for Screening Pap Tests and HPV Tests
HCPCS Codes for Physicians Interpretation of Screening Pap Tests
HCPCS Code for Laboratory Specimen of Screening Pap Tests
HCPCS Code for Screening Pelvic Exams
Diagnosis Codes and Descriptors
Report one of the ICD-10 diagnosis codes listed in the table below for screening Pap tests, pelvic exams, and HPV screening. Indicate the patient’s low- or high-risk status with the appropriate diagnosis code.
Screening Pap Tests and Pelvic Exams Diagnosis Codes
Common Claim Denial Reasons
Medicare may deny screening Pap tests, pelvic exams, and HPV screenings in several situations, including:
- The patient (not at high risk) got a covered screening within the past 2 years
- The patient (at high risk) got a covered screening within the past year
- The patient (at high risk) got a covered HPV screening within the past 5 years (that is, at least 4 years and 11 months [59 months total] after the most recent HPV screening)