# Medicare Breast exam without pap or pelvic exam



## Choughton (Dec 8, 2011)

How would you bill Medicare for a patient scheduled for her annual gyn exam w/ pap, but elects only for a full H&P w/ breast exam  Thanks!


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## cheermom68 (Dec 8, 2011)

*breast exam*

Breast exam is included in the E&M.
LeeAnn


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## andyrobin (Dec 8, 2011)

I have never tried this before with Medicare, but their is a HCPCS code S0613.  Would we not just carve that out from the E/M?

Robin King, CPC


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## Choughton (Dec 9, 2011)

*The E&M...*



cheermom68 said:


> Breast exam is included in the E&M.
> LeeAnn



Are you referring to the 99211-99214's or the G0101 w/ 99-GA-52?


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## cheermom68 (Dec 9, 2011)

*Breast exam*

When only a breast exam is performed with no other parts of the pelvic exam it would be included in the office visit 992**.  In my experience Medicare will not pay the S codes, those are generally Anthem codes.  The G0101 requires 7 elements of the pelvic exam, I would not consider doing one of them enough to bill the G0101 with a 52 modifier.  (in my opinion)


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## Choughton (Dec 9, 2011)

*Thanks!*

Thanks..., and Happy Holidays!!


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## ajs (Dec 9, 2011)

Choughton said:


> How would you bill Medicare for a patient scheduled for her annual gyn exam w/ pap, but elects only for a full H&P w/ breast exam  Thanks!



So did the patient elect not to have a pelvic exam either?  If she had a complete routine physical exam but declined the pelvic exam, you just bill a preventive medicine E/M the breast exam is included and it will not be covered by Medicare, unless she was having the new wellness exam that is allowed by Medicare.  But those exams only cover very specific screenings, not complete physicial exams.

If she did have a pelvic and breast exam, just no pap test then you can bill the G0101 code with a GA modifier (as long as she signed the ABN) and carve that out of the preventive E/M code for the complete physical exam.

All depends on what was documented.


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## Choughton (Dec 9, 2011)

Thank you;-)


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## andyrobin (Dec 9, 2011)

Thanks Arlene.  Good to know for the future.  


Robin King, CPC


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