Coding Tip: Reporting HCPCS Code Q0091

Reporting HCPCS code Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)

Non-Medicare Payers:
Code Q0091 should not be reported to private payers for pap smear collection. The collection of a pap smear is included in the E/M or preventive medicine service.

Some private payers do reimburse for the Q0091 code. In such cases, ACOG strongly recommends obtaining the guidelines for that specific policy in writing.

Medicare:
Q0091 is a code developed by Medicare for services provided to Medicare patients. Medicare does not reimburse for preventive services, such as those reported with CPT-4 codes 99384 – 99397. Medicare allows payment of code Q0091 as an exception to its general rule. Providers should report code Q0091 to Medicare for the collection of screening pap smears for Medicare patients.

However, collection of a diagnostic pap smear for a Medicare patient (performed due to illness, disease, or symptoms indicating a medically necessary reason) is included in the physical examination portion of a problem-oriented E/M service and is not reported or reimbursed separately.

Questions and/or comments may be sent to coding@acog.org