What is the CPT (Current Procedural Terminology) code for a routine pap smear test in a female patient between 21 and 65 years old with no history of cervical cancer or abnormal pap smear results?

CPT Codes for Routine Pap Smear Testing

For a routine Pap smear in women aged 21-65 with no history of cervical cancer or abnormal results, the primary CPT codes are 88141-88175 for the cytopathology interpretation, with the specimen collection typically coded separately using 99000 or facility-specific codes.

Specimen Collection Codes

The collection of the cervical/vaginal cytology specimen during the clinical encounter is typically reported with:

• G0101 (Medicare-specific code for cervical/vaginal cytology screening)
• Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)
• Alternatively, some practices use 99000 for specimen handling

The actual pelvic examination is coded separately and is not part of the Pap smear code itself 1.

Laboratory Interpretation Codes

The cytopathology laboratory interpretation uses different CPT codes based on the method:

Conventional Pap Smear

• 88164 - Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision
• 88165 - with manual screening and rescreening under physician supervision

Liquid-Based Cytology (Thin-Layer Preparation)

• 88142 - Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision
• 88143 - with manual screening and computer-assisted rescreening under physician supervision
• 88147 - cytopathology smears, cervical or vaginal; screening by automated system under physician supervision
• 88148 - screening by automated system with manual rescreening under physician supervision

Both conventional and liquid-based cytology methods are acceptable for routine screening 1.

HPV Co-Testing Codes (Age 30-65)

For women aged 30-65 years, HPV DNA testing may be performed with the Pap test (co-testing), which is the preferred approach and allows for 5-year screening intervals 1, 2, 3:

• 87624 - Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (e.g., 16,18,31,33,35,39,45,51,52,56,58,59,68)
• 87625 - Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed

Important caveat: HPV testing should NOT be used for women aged 21-29 years for routine screening 1, 3.

Screening Interval Considerations

The appropriate screening intervals affect coding frequency 1, 2:

• Ages 21-29: Pap test alone every 3 years
• Ages 30-65: Either Pap + HPV co-testing every 5 years (preferred) OR Pap test alone every 3 years
• Over age 65: Discontinue screening if adequate prior normal results

Medicare Coverage Codes

Medicare covers Pap testing using specific HCPCS codes 2:

• G0123 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision (for beneficiaries at high risk)
• G0124 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician (for beneficiaries at high risk)
• G0141 - Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
• G0143 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
• G0144 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
• G0145 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
• G0147 - Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
• G0148 - Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening

Medicare allows screening at 3-year intervals for average-risk women, or yearly for high-risk women 2.

Common Coding Pitfalls

• Do not confuse the collection code with the interpretation code - these are separate services that may be billed by different providers 4
• Verify CLIA certification - laboratories performing cytopathology must be CLIA-certified to bill for these services 1
• Document whether screening was performed - women often incorrectly believe a Pap test was obtained when only a pelvic exam was done, so clear documentation is essential 1, 2
• Avoid over-screening - annual Pap tests are not recommended and may not be reimbursed for average-risk women 1, 2