Pathology/Lab Coding Alert

Beginning July 1, 2001, Medicare will pay for a screening Pap smear for low-risk patients once every two years, rather than once every three years as previously covered. Frequency guidelines for high-risk patients do not change.

A screening Pap smear is carried out to screen for cervical or vaginal cancer in the absence of signs or symptoms of disease. For patients with a personal history that increases risk for these diseases, the screening Pap smear has been, and may continue to be, conducted once a year.

However, for patients with no symptoms and no personal history indicating high risk for cervical or vaginal cancer, Medicare will now cover Pap smears once every two years. This change is due to the Consolidated Appropriations Act of 2001, to provide coverage for biennial Pap smears, modifying the existing law that provides coverage once every three years. All other coverage and payment requirements remain the same.

Under the new rules, for claims with dates of service on or after July 1, 2001, Medicare will pay for a screening Pap smear for a low-risk patient after at least 23 months have passed following the month during which the patient received her last covered screening Pap smear. For example, if the patients last screening Pap smear was August 1999, start your count with September 1999. The patient is eligible to receive another screening Pap smear in August 2001, the month after 23 months have passed.

For Medicares announcement of this change, visit HCFAs program transmittal page: www.hcfa.gov/ pubforms/transmit/transmittals/comm_date_dsc.htm and select file R1823.A3 from the file column.