Medicare provides coverage for both screening and Diagnostic Pap smear and correct way of billing and coding Pap smear depend upon choosing the right CPT code for Diagnostic and screening pap smear.

A cervical screening test (previously known as a smear test) is a method of detecting abnormal cells on the cervix. The cervix is the entrance to the womb from the vagina. Detecting and removing abnormal cervical cells can prevent cervical cancer.

Medicare coverage for Pap test

  • Covered in every 24 months for all female having no symptoms of illness.
  • Covered in every 12 months in case if patient has high risk for cervical or vaginal cancer, in childbearing age and had an abnormal Pap test in the past 36 months. Refer to the CMS National Coverage Determination (NCD) for high-risk criteria.

Medicare coverage for Pap smear, Screening and Diagnostic

Screening Pap smears

When patient does not have signs and symptoms of cervical, uterine or vaginal cancer.
Use following HCPCS codes for screening Pap smear

G0147, G0148, P3000, P3001 and Q0091

Diagnostic Pap smears
When patient have an abnormal Pap smear or have signs or symptoms of cervical, uterine or vaginal cancer. Use following CPT codes for Diagnostic Pap smear billing and coding.


Note: Medicare may deny coverage if Low or high risk case are not reported with appropriate Diagnosis code. So please also use appropriate ICD-9-CM Diagnosis Code
in above mentioned cases.

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