2025 HCPCS code G0101
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Cervical/Vaginal Cancer Screening Screening Examinations and Disease Management Training Feed
This HCPCS code represents a cervical or vaginal cancer screening that includes a pelvic and clinical breast examination.
Modifiers may apply depending on the circumstances of the service; consult payer guidelines for specifics.For example, modifier 25 may be used if a significant and separately identifiable E/M service was performed on the same day.
Medical necessity for G0101 is established by the patient's age, risk factors for cervical or vaginal cancer, and the need for routine screening or follow-up care.Frequency is based on risk; annual screening is recommended for high-risk patients, while biennial screening is typical for low-risk individuals.Documentation must support the medical necessity of the procedure.
The clinical responsibility for G0101 rests with the physician or qualified healthcare professional performing the examination. This includes taking a thorough history, performing a complete physical examination, interpreting the findings, and providing appropriate counseling or referrals.
- Screening Examinations and Disease Management Training
- G0101 falls under the HCPCS Level II codes for screening examinations and disease management training.
In simple words: This code covers a doctor's exam to check for cervical or vaginal cancer. The exam includes checking the breasts for lumps and doing a pelvic exam to examine the vagina, cervix, and other pelvic organs.
HCPCS code G0101, "Cervical or vaginal cancer screening; pelvic and clinical breast examination," encompasses a comprehensive screening procedure for women.It involves a thorough clinical breast examination, palpating the breasts for lumps, tenderness, symmetry, and nipple discharge.The pelvic examination includes inspecting and palpating the external genitalia, urethral meatus, urethra, bladder, vagina (assessing appearance, estrogen effect, discharge, lesions, and pelvic support), cervix, uterus (size, contour, position, mobility, tenderness, consistency, descent, and support), adnexa/parametria, anus, and perineum.The procedure may or may not include specimen collection for smears and cultures.Specific diagnostic codes, dependent on risk factors, are required for proper billing.
Example 1: A 21-year-old female presents for her first annual well-woman visit.The physician performs a complete pelvic and clinical breast examination, including pap smear (billed separately with Q0091). No abnormalities are detected., A 35-year-old female with a history of abnormal Pap smears presents for a repeat screening. The physician performs a complete pelvic and clinical breast examination, noting an area of concern on the cervix. A colposcopy is performed and billed separately., A 45-year-old female with a family history of breast cancer undergoes a routine well-woman exam. The physician performs a complete pelvic and clinical breast examination; a mammogram is ordered and billed separately.
Comprehensive documentation is essential and should include the date of service, a detailed description of the examination performed (including all 7 required components of the pelvic exam from the Noridian guideline), a clear indication of the patient's risk status for cervical or vaginal cancer, any abnormalities found, and any additional services provided (such as pap smears or other tests).The documentation must support medical necessity.
** Always verify payer-specific coverage and coding guidelines before billing.G0101 is specifically for Medicare beneficiaries; private payers may have different codes and requirements.
- RVU: RVUs for G0101 vary based on geographic location and other factors.Consult your specific payer's fee schedule for current RVU values and reimbursement rates.
- Global Days: This code does not have a global period.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to G0101.
- Fee Schedule: Historical fee schedule data for G0101 is available from CMS and other payer websites.This information is subject to change.
- Specialties:Obstetrics and Gynecology, Family Medicine
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center