Page 269 - Medicare Benefit Policy Manual

35-39 (Baseline). Pay for only one screening mammography performed on a
woman between her 35th and 40th birthday.

Over age 39 For a woman over 39, pay for a screening mammography performed
after 11 full months have passed following the month in which the last
screening mammography was performed.

To determine the 11-month period, A/B MACs (A) and (B) start counting beginning with
the month after the month in which a previous screening mammography was performed.

EXAMPLE: If Mrs. Smith received a screening mammography examination in January
1998, begin counting the next month (February 1998) until 11 months have elapsed.
Payment can be made for another screening mammography in January 1999.

See the Medicare Claims Processing Manual, Chapter 18, “Preventive and Screening
Services,” §30, for billing and payment instructions.

280.4 - Screening Pap Smears
(Rev. 194, Issued: 09-03-14, Effective: Upon Implementation of ICD-10,
Implementation: Upon Implementation of ICD-10)

Effective, January 1, 1998, §4102 of the Balanced Budget Act (BBA) of 1997 (P.L. 105-
33) amended §1861(nn) of the Act (42 USC 1395X(nn)) to include coverage every 3
years for a screening Pap smear or more frequent coverage for women:

1. At high risk for cervical or vaginal cancer; or

2. Of childbearing age who have had a Pap smear during any of the preceding 3 years
indicating the presence of cervical or vaginal cancer or other abnormality.

Effective July 1, 2001, the Consolidated Appropriations Act of 2001 (P.L. 106-554)
modifies §1861(nn) to provide Medicare coverage for biennial screening Pap smears.
Specifications for frequency limitations are defined below.

For claims with dates of service from January 1, 1998, through June 30, 2001, screening
Pap smears are covered when ordered and collected by a doctor of medicine or
osteopathy (as defined in §1861(r)(1) of the Act), or other authorized practitioner (e.g., a
certified nurse midwife, physician assistant, nurse practitioner, or clinical nurse specialist,
who is authorized under State law to perform the examination) under one of the following
conditions.

The beneficiary has not had a screening Pap smear test during the preceding 3 years (i.e.,
35 months have passed following the month that the woman had the last covered Pap
smear – ICD-9-CM code V76.2 or ICD-10 code Z112.4 is used to indicate special
screening for malignant neoplasm, cervix); or