Effective 1/1/2017, HMSA’s commercial plans include laboratory benefits for one routine screening Pap smear every 3 years for women beginning at age 21 years old through age 65 years old. This is consistent with the recommendations provided by the United States Preventive Services Task Force, Bright Futures, the American Cancer Society and the American College of Obstetricians and Gynecologists.
Claims Filing Information
The codes referenced below may be billed for screening Pap smear. Please use the appropriate code.
| CPT or HCPCS code | Description |
|---|---|
| 88141 | Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician |
| 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; with manual screening and rescreening under physician supervision |
| 88147 | Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision |
| 88148 | Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician |
| 88150 | Cytopathology, slides, cervical or vaginal; manual screening under physician supervision |
| 88152 | Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision |
| 88153 | Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision |
| 88154 | Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening using cell selection and review under physician supervision |
| 88155 | Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services) |
| 88164 | Cytopathology, slides, cervical or vaginal, (the Bethesda System); manual screening under physician supervision |
| 88165 | Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision |
| 88166 | Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision |
| 88167 | Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision |
| 88174 | Cytopathology, cervical of vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system under physician supervision |
| 88175 | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision |
| G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
| G0124 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician |
| G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician |
| G0143 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision |
| G0144 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
| G0147 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision |
| G0148 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening |
| P3000 | Screening Papanicolaou smear, cervical or vaginal, up to 3 smears, by technician under physician supervision |
| P3001 | Screening Papanicolaou smear, cervical or vaginal, up to 3 smears, requiring interpretation by physician |
Routine readings performed by a pathologist to meet quality assurance standards should not be billed to HMSA. CPT code 88141 should be billed only when physician interpretation is needed to make a clinical diagnosis.
For professional claims, the applicable ICD-10 code must be identified as the primary line diagnosis to ensure appropriate application of benefits.
| ICD-10 code | Description |
|---|---|
| Z01.411 | Encounter for gynecological examination (general) (routine) with abnormal findings |
| Z01.419 | Encounter for gynecological examination (general) (routine) without abnormal findings |
| Z01.42 | Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear |
| Z12.4 | Encounter for screening for malignant neoplasm of cervix |
Note: The codes referenced above should not be used to represent specimen collection.
HMSA reserves the right to perform retrospective reviews.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |