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June 2003 · Vol. 15, No. 6

REIMBURSEMENT ADVISER

Medicare coding guidelines for cancer screening

Melanie  Witt,  RN, CPC, MA

Q

Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A

For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

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