Code G0101 and Q0091

I am confused about using G0101, I was under the impression both these codes could only be used for Medicare patients. I have a patient who came to see us at the obgyn who has bcbs. Dr did screening breast exam without pelvic exam. Do I bill an E/M code or do I bill G0101 with modifier 52 since the pelvic was not done?

Bcbs

medicare rules: HCPCS code G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) may be reported with evaluation and management (E&M) services under certain circumstances. If a Medicare covered E&M service requires breast and pelvic examination, HCPCS code G0101 should not be additionally reported. However, if the Medicare covered E&M service and the screening services, G0101, are unrelated to one another, both HCPCS code G0101 and the E&M service may be reported appending modifier -25 to the E&M service CPT code. Use of modifier -25 indicates that the E&M service is significant and separately identifiable from the screening service, G0101. All components of code must be satisfied. Check with BCBS as to their policy on this code.

Codes G0101 and Q0091

There are many articles in Codapedia about this topic. Search "G0101" "Well woman exams" and "preventive care."

G0101 requires 7 of the 11 exam bullets, so you could not use it for breast exam alone.