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PAP 275

HCPCS Q0091, G0101-G0102, and S0610-S0612 with Evaluation & Management Services


Provider Administrative Policy

Section
Claims Submission
Policy Date
May 2012
Status/Date
New/May 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

HCPCS Q0091, G0101-G0102, and S0610-S0612 with Evaluation & Management Services

Q0091 - Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
G0101 - Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0102 - Prostate cancer screening; digital rectal examination
S0610 - Annual gynecological examination, new patient
S0612 - Annual gynecological examination, established patient

The five HCPCS codes listed above are components of evaluation and management (E/M) services and are not separately payable. If one of the HCPCS codes listed above is billed on the same date of service as an E/M service from the same provider, we will deny the HCPCS as a bundled service. We will not accept a bypass modifier of 59 or 25 on these code pairs.

If you bill any of these five codes alone to report a preventive service, without an E/M code, the service will be allowed according to the member's benefit. However, when you bill multiple HCPCS describing a similar service together, we will deny one of the codes. For example, we will deny Q0091 when billed with any of the three codes; G0101, S0610, or S0612 since those services include a pap smear. Additionally, we will deny S0610 or S0612 if billed on the same claim as G0101. We will also deny S0610 if billed on the same claim as S0612 - the patient is either 'new' or 'established', not both.

This policy does not apply to Medicare Advantage claims that follow National Correct Coding Initiative (NCCI) standards that typically pay the HCPCS code, but bundle the medical E/M service.


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