While standard commercial payers usually bundle Pap smear collections into the E/M visit, Medicare pays separately for the collection using Q0091.
Billing Requirements for Q0091
Q0091 is solely for the work of obtaining the Pap smear specimen (the scraping). It does not include the laboratory interpretation of the smear.
Like G0101, the frequency is every 24 months for low-risk patients and every 12 months for high-risk patients.
Medical Necessity ICD-10 Codes
Your claim must include a valid screening diagnosis code, such as:
- Z12.4 - Encounter for screening for malignant neoplasm of cervix
- Z77.9 - High-risk encounter code (if applicable)
NCCI Edits
Q0091 can be billed with a standard E/M (with Modifier 25) and with G0101 (Pelvic exam) on the same date of service. Ensure your combinations pass NCCI validation.