Well-Woman Exam

Annual Gynecological Examination

HMSA’s commercial and QUEST Integration plans include benefit coverage for one gynecological examination for women per calendar year. The annual well-woman exam generally should include a pelvic examination, a clinical breast examination and the collection of a specimen for Pap Smear screening when performed.

Visits should also include referrals to appropriate screening services as needed.

Note: For QUEST members, no referral is required.

A well-woman exam should be billed when the patient sees the physician specifically for a routine annual gynecological examination. If the patient has gynecological symptoms (e.g., dysmenorrhea) that the physician must evaluate and manage, an E/M visit may be billed.

Claims Filing Instructions

Please bill the annual well-woman examination using the following procedure and diagnosis codes:

Effective January 1, 2026, the annual well-woman examination should be billed with one of the following HCPCS:

Note – HCPCS G0101 will no longer be accepted for benefits effective January 1, 2026.

Do not bill for performing the laboratory services associated with the Pap smear, unless you have a CLIA-approved laboratory in your office and have performed the laboratory services. If the specimen is sent to an outside laboratory, the laboratory will bill HMSA directly.

Revision History