Forum - Questions & Answers
Medicare and annual exams
Does Medicare pay for annual pap exams? If so, how should I code it? I work for an FQHC. Does that make a difference in billing?
I believe I need to use a G code along with Q0091.
re: Medicare and annual exams
TC–Not Covered in FQHC
The technical component of the following specific preventive services (the professional component is an FQHC service if performed by an FQHC physician or NPP):
• Screening Pap smears and screening pelvic exams
• Prostate cancer screening
• Colorectal cancer screening tests
• Screening mammography
• Bone mass measurements
• Glaucoma screening.
The services of a physician performed at the clinic are FQHC services and are payable only to the clinic.The professional component of a screening Pap smear furnished within an FQHC by a physician or nonphysician is considered an FQHC service.
FQHCs bill the contractor under bill type 77X for the professional component along with revenue code 052X. The technical component of a screening Pap smear is
outside the scope of the FQHC benefit. If the technical component of this service is furnished within a freestanding FQHC, the provider of that technical service bills the contractor on the CMS-1500.
• If the technical component of a screening Pap smear is furnished within a provider-based FQHC, the provider of that service bills the contractor under bill
type 13X, 14X, 22X, 23X or 85X, as appropriate, using its outpatient CCN (not the FQHC’s CCN, since these services are not covered as FQHC services).