If you have general questions, questions regarding a particular claim, or need help completing your claim form when reporting the use of BD PrepStain™ Slide Processor, or BD FocalPoint™ Slide Profiler for conventional or BD SurePath™ slides, please contact one of our Regional Payer Relations Managers.

CPT Codes and HCPCS Codes

Because Medicare distinguishes between screening and diagnostic Pap smear screening, it was necessary for HCFA to obtain separate screening (HCPCS) and diagnostic (CPT) codes. For more information, see the CPT & HCPCS Code Clarifications.

Applicable CPT and HCPCS Codes for Cervical Cytology Screening
	CPT Code	HCPCS Code
Manual screening of BD SurePath™ thin-layer slides.	88142	G0123
Manual screening and rescreening of BD SurePath™ thin-layer slides.	88143	G0143
BD FocalPoint™ Directed QC™ "review" screening of conventional slides.	88166	P3000
BD FocalPoint™ screening of conventional slides with No Further Review.	88147	G0147
BD FocalPoint™ screening of conventional slides with Manual Review.	88148	G0148
BD FocalPoint™ screening of BD SurePath™ slides with No Further Review.	88174	G0144
BD FocalPoint™ screening of BD SurePath™ slides with Manual Review.	88175	G0145

Medicare National Limitation Amount Effective January 1, 2006

CMS reviewed the pricing for the existing CPT codes and the new CPT codes representing cervical cancer screening and established new reimbursement rates effective January 1, 2003. For the new CPT Codes that represent the Integrated System of BD SurePath™ slides on the BD FocalPoint™ Slide Profiler , CMS cross-walked the existing local fees for the BD SurePath™ slides to a percentage of the local fees for the BD FocalPoint™ Slide Profiler to establish the National Limitation Amounts and the carrier local fees. The minimum payable amount for any of these new codes was increased to $14.76 for 2006. For the exact amounts of fees established by each state carrier, contact your Regional Payer Relations Managers.

Professional Component Fee

CMS pays a fee for the professional component of Pap smear screening, separate from the codes listed above. Please refer to the Medicare Physician Fee Schedule for appropriate coding and reimbursement.

Reimbursement Codes Classification

Reporting Screening and Diagnostic Pap Smears

Medicare differentiates between "screening" and "diagnostic" Pap smears due to statutory limitations on the frequency of allowed payment for "screening" Pap smears. Diagnostic Pap smears (performed because there are signs or symptoms of disease) are reported using all numeric CPT codes. Screening Pap smears (performed in the absence of signs or symptoms of disease) are reported using alphanumeric HCPCS (regardless of test results).

While the terminology for the HCPCS codes for screening Pap smears generally parallels the terminology in CPT for diagnostic Pap smears, two modifications have been made to avoid confusion over the meaning of the word "screening". In CPT the word "screening" refers to the evaluation of the specimen by the cytotechnologist. In HCPCS, the word "evaluation" has been used instead. In HCPCS, the word "screening" describes the reason for the test was performed (i.e., in the absence of signs and symptoms).

HCPCS (HCFA Common Procedure Coding System) Code Definitions

G0123 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, evaluation by cytotechnologist under physician supervision.

G0143 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual evaluation and reevaluation by cytotechnologist under physician supervision.

P3000 - Screening Papanicolaou smear, cervical or vaginal, up to three smears, (any reporting system), evaluation by cytotechnologist under physician supervision.

G0147 - Screening cytopathology smears, cervical or vaginal; performed by automated system under physician supervision. This code is used to report an automated primary evaluation rather than an automated quality control step.

G0148 - Screening cytopathology smears, cervical or vaginal, performed by automated system with manual reevaluation under physician supervision. This code is used to report an automated primary evaluation rather than an automated quality control step.

G0144 - Screening cytopathology, cervical or vaginal (any reporting system), collected in a preservative fluid, automated thin layer preparation; performed by automated system, under physician supervision.

G0145 - Screening cytopathology, cervical or vaginal (any reporting system), collected in apreservative automated thin layer preparation; performed by automated system and manual rescreening or review, under physician supervision.

CPT (Current Procedural Terminology) Code Definitions

88142 - Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision.

88143 - Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening and re-screening under physician supervision.

88166 - Cytopathology smears, cervical or vaginal (Bethesda System reporting); manual screening and automated rescreening under physician supervision (Automated rescreening code for "review" slides).

88147 - Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision (Automated primary screening code for "no further review" slides).

88148 - Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening (Automated primary screening code for slides reviewed by human).

88174 - Cytopathology, cervical or vaginal (any reporting system), collected in a preservative fluid, automated thin layer preparation; with screening by automated system, under physician supervision.

88175 - Cytopathology, cervical or vaginal (any reporting system), collected in a preservative
fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision.

A Note on Statutory Limitations

Effective July 1, 2001, the Consolidated Appropriations Act of 2001, Public Law 106-554 (enacted on December 21, 2000) changes the frequency limitations from 3 to 2 years for screening Pap smears and screening pelvic examinations performed on qualified female beneficiaries.

CPT Code for Reporting Immunocytochemical or Immunohistochemical (ICC, IHC) testing

Immunocytochemical testing is a general use application of reagents and antibodies for the detection of abnormalities within a cytologic specimen. The application and development of these antibodies and the associated protocols are developed by the laboratory using readily available reagents and antibodies performed in a self-validated, home brew process within CLIA guidelines.

Procedural reporting of an Immunocytochemistry test is accomplished by the use of a general application CPT code intended for both Immunohistochemical and Immunocytochemical applications.

CPT Code for Reporting Non-Gynecologic testing

Effective 1-1-04 a new CPT code has been established that identifies the physician services for non-gynecologic applications for BD CytoRich™ preservative .