Revised Reporting for Pap Smear Tests

In accordance with the 2006 updates to the Current Procedural Terminology – 4th Edition (CPT-4 code book), the provider manual has been updated to reflect changes in reporting for codes used to bill for Pap smear tests.

This section contains information to assist providers in billing for pathology procedures related to cytopathology services.

Pap Smear Tests

Taking a Papanicolaou (Pap) smear sample is considered part of a pelvic examination and is not separately reimbursable. The Pap smear test is reimbursable only to the provider who performs and reads the Pap smear and issues the written report. These tests include up to three smears for Pap tests for cancer screening and/or a qualitative report on the patient’s level of estrogen.

Modifiers -TC, -ZS and -26

Providers may use modifiers -TC or -ZS to bill cervical or vaginal Pap smear results. When a smear is billed with modifier -26, it is reimbursable only to a hospital pathologist whose service is not covered by the hospital.

Clinical or Hospital laboratory

Pap smears examined in a clinical or hospital can be Laboratory reimbursed with modifier -ZS only if both the professional and technical components are performed in the laboratory.

Billing Restrictions

CPT-4 codes 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88164, 88165, 88166 or 88167, 88174 or 88175 may be used to bill cervical or vaginal Pap smear tests and to report physician interpretation services. Reimbursement is limited to one Pap smear in 30 days when billed by any provider, for the same recipient.

Physicians, hospital outpatient departments and clinical laboratories may bill using codes 88147 and 88148.

Note: Clinical laboratories must use technical component modifier -TC when billing for these services.

CPT-4 code 88141 (cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician) is used to report smears that require separate interpretation by a physician. Providers must bill CPT-4 code 88141 with modifier -26. This code is not to be used to bill routine quality control measures used in the supervision of technicians.

Note: Same day billing is allowed for code 88141 and a Pap smear code (88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88164, 88165, 88166 or 88167, 88174 and 88175) when a smear requiring separate physician interpretation is detected and documented on the claim. Same day billing for these codes is not allowed for the routine quality control re-examination of slides made by a technical supervisor or pathologist.

Optical Imaging Evaluations

CPT-4 code 88152 (cytopathology, slides, cervical or vaginal; with manual screening and computer- assisted rescreening under physician supervision) describes an improved technology using optical imaging equipment to routinely evaluate negative smears. This code is not to be used to bill routine quality control measures used in the supervision of technicians.

Hormonal Evaluation

CPT-4 code 88155 is reimbursable for Pap smears performed for a definitive hormonal evaluation, and may be billed in conjunction with codes 88141 – 88143, 88147, 88148, 88150, 88152 – 88154 or 88164 – 88167, 88174 and 88175. Medical justification must be documented in the Remarks area/Reserved For Local Use field (Box 19) of the claim or on an attachment. Code 88155 is reimbursable once in 30 days when billed by the same provider for the same recipient.

Fine Needle Aspirates

CPT-4 codes 88172 and 88173 are used for billing the cytopathology evaluations of fine needle aspirates. Code 88199 or other “By Report” codes for this procedure will be denied. Providers must use the appropriate modifier when billing these procedures.