Reporting HCPCS Code G0101 When Organs are Surgically Absent

It has been noted that some Medicare(CMS) contractors are declining payment for the routine pelvic  and breast examinations associated with HCPCS code G0101 (cervical or vaginal cancer screening). Specifically, payment has been denied when the documentation includes notation of surgically absent organs as part of the seven of eleven required exam components.

The ACOG Health Economics and Coding Committee has reviewed this issue and has determined that HCPCS code G0101 should be covered if the documentation notes the absence of the breast(s), cervix, uterus, fallopian tube(s), and/or ovary(s).  The breast and pelvic examinations often discover new pathology even in the absence of certain organs.  

ACOG fellows should continue to submit bills using HCPCS Code G0101, and, when appropriate, note that specific organs are surgically absent. Documentation of surgically absent organ(s) suffices as one or more of the required examination components.

The ACOG Health Economics and Coding Committee can provide additional written information and answer other questions, if requested.

Contact:

Donna Tyler
Manager, Coding Education
dtyler@acog.org

Keisha Sutton
Coding Specialist
ksutton@acog.org