Coding Tip Reporting HCPCS Code Q0091 Screening Papanicolaou smear obtaining preparing and conveyance of cervical or vaginal smear to laboratory

Non-Medicare Payers:

HCPCS 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:

Medicare pays for certain screening preventive services, including the collection of screening pap smears.  Code Q0091 was developed by CMS for reporting the collection of screening pap smears for Medicare patients.  Medicare does not reimburse for the comprehensive preventive services that are reported with CPT-4 codes 99384 – 99397.

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.

ACOG has prepared a document that describes the correct coding for all of Medicare’s preventive services.  It can be found through a link on ACOG’s web site here.

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