TMPPM 2008 > Texas Medicaid Services > Physician > Procedures and Services

36.4.9.5 Cytopathology Studies-Gynecological, Pap Smears

Pap smears are a benefit of the Texas Medicaid Program for early detection of cancer. Family planning clients are eligible for annual Pap smears.

Procurement and handling of the Pap smear are considered part of the E/M of the client and are not reimbursed separately.

The following procedure codes are reimbursed only to pathologists and CLIA-certified laboratories (whose directors providing technical supervision of cytopathology services are pathologists):

These procedure codes are payable in the POS where the Pap smear is interpreted: POS 1 (office), POS 3 (inpatient), POS 5 (outpatient), or POS 6 (independent laboratory).

The interpretation portion of any gynecological cytopathology test must be reported using procedure code I-88141. It is inappropriate to use the following procedure codes to bill for the interpretation:

Procedure code I-88141 remains a benefit. Its reimbursement is restricted to laboratories and pathologists. It is reimbursed in addition to the technical component. The following procedure codes are payable for TOS 5 only:

Procedure code 5-88155 is a benefit but is not reimbursed when billed in addition to the following cytopathology procedure codes:

Procedure code 5-88144 is not a benefit because the procedure it describes has not been FDA-approved.

The Pap smears procedure codes (in the table below), are not reimbursed separately to either the physician or a laboratory when submitted with the same date of service as a THSteps medical check up visit (procedure codes S-99381, S-99382, S-99383, S-99384, S-99385, S-99391, S-99392, S-99393, S-99394, and S-99395).

Refer to: "Cervical Cancer Screening" for more information about THSteps and laboratory procedure benefits.