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pelvic axam (non medicare)

Marilyn Posted Tue 10th of May, 2011 17:54:42 PM

What is the cpt code for a non medicare pelvic exam?

SuperCoder Answered Tue 10th of May, 2011 18:40:34 PM

For Medicare, it is G0101. Some carriers may bill E&M for any issues that patient may be having (Sx of menopause, vaginitis etc..) and G0101 for pelvic. So for non medicare, I would suggest to bill one of the preventative medicine E/M services CPT codes (99381-99397 series) that fits the level of service done. A pelvic exam is part of the yearly preventive visit but also will be done for diagnostic reasons. If the total exam and visit would not be strictly for preventive but diagnostic, then that type of visit would not be appropriate. Some health plans will pay G0101, Q0091, S0610 and/or S0612. Some will pay one or another, some will pay a combination of two, others will pay certain ones with a preventive visit (9938x-9939x series) and others will not. Some will only pay the HCPCS codes above with an Office Visit (9920x-9921x series) and others will not. Please refer this link to know more information.
http://www.acog.org/departments/coding/MedicareScreeningServices.pdf

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