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G0101 HCPCS Code: Medicare Pelvic & Breast Exam Guidelines

Last Updated: May 23, 2026

Medicare covers screening pelvic and clinical breast exams using G0101 ↗, but the frequency limits depend entirely on the patient's risk factors.

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2026 Medicare National Fee (G0101): Non-Facility (Office): $49.11 · Facility (Hospital): $27.92

Frequency: High Risk vs Low Risk

If the patient is considered "low risk," Medicare covers G0101 once every 24 months. If the patient is considered "high risk" (e.g., history of cervical cancer, early onset of sexual activity), Medicare covers it once every 12 months.

Medical Necessity: The 7 Elements

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To bill G0101, the exam must include at least 7 of the following 11 elements: Inspection/palpation of breasts, digital rectal exam, pelvic exam (external genitalia, urethral meatus, urethra, bladder, vagina, cervix, uterus, adnexa/parametria, anus/perineum). Diagnosis code Z01.419 ↗ is commonly used.

NCCI Edits and Q0091

G0101 is almost always billed alongside Q0091 ↗ (Obtaining screen pap smear). They are separate services and do not bundle into each other.

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