Screening Pap Smears
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 three 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
three 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
three 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 is used to indicate special
screening for malignant neoplasm, cervix); or
There is evidence (on the basis of her medical history or other findings) that
she is of childbearing age and has had an examination that indicated the
presence of cervical or vaginal cancer or other abnormalities during any of the
preceding three years; and at least 11 months have passed following the month
that the last covered Pap smear was performed; or
