- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Screening for Cervical Cancer with Human Papillomavirus Tests
Cervical cancer is commonly caused by the HPV. The USPSTF found that regular screening greatly reduces the rate of cervical cancer and the number of related deaths.
Coverage Criteria and Frequency Limits
- Coverage every five years for asymptomatic female patients age 30 to 65 years in conjunction with the pap smear test
- U.S. FDA-approved/cleared laboratory tests, used consistent with FDA-approved labeling, and in compliance with the CLIA regulations
- Effective for claims dates of service on or after 7/9/2015
HCPCS/CPT Coding
- G0476: Infectious agent detection by nucleic acid (DNA or RNA); HPV, high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test
ICD-10 Codes
- Z11.51 and either Z01.411 or Z01.419
Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service and contact your Medicare Administrative Contractor (MAC) for guidance.
Billing Tips
- A covered E/M visit can be billed on the same claim as Q0091
- Report modifier 25 on the E/M service
- Clearly document the medical necessity of a separately identifiable E/M service in the patients’ medical record
Who Can Perform?
- Must be ordered and collected by DM, DO or other qualified NPP
- Qualified NPPs (certified nurse midwife, physician assistant, nurse practitioner and clinical nurse specialist)
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denial Reasons
- Patient not at high risk and received covered screening within past two years
- High-risk patient received covered screening within past year
Related Content
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.4
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 30
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, Section 210.2
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 10/12/2023