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CMSNational Coverage Determination (NCD)

CMS Diagnostic Pap Smears Form


Diagnostic Pap Smear

Notes: For coverage of Screening Pap Smears and Pelvic Examinations for early detection of cervical or vaginal cancer, see Medicare National Coverage Determination (NCD) section 210.2.

Indications

(883071) Has the patient previously been diagnosed with or currently being treated for cancer of the cervix, uterus, or vagina? 
(883072) Has the patient had a previous abnormal pap smear result? 
(883073) Are there any abnormal findings of the vagina, cervix, uterus, ovaries, or adnexa 
(883074) Does the patient have significant complaints referable to the female reproductive system? 
(883075) Are there signs or symptoms that might in the physician's judgment reasonably be related to a gynecologic disorder? 

Effective Date

06/19/2006

Last Reviewed

NA

Original Document

  Reference



CIM 50-20, CIM 50-20.1

A diagnostic pap smear and related medically necessary services are covered under Medicare Part B when ordered by a physician under one of the following conditions:

  • Previous cancer of the cervix, uterus, or vagina that has been or is presently being treated;
  • Previous abnormal pap smear;
  • Any abnormal findings of the vagina, cervix, uterus, ovaries, or adnexa;
  • Any significant complaint by the patient referable to the female reproductive system; or
  • Any signs or symptoms that might in the physician's judgment reasonably be related to a gynecologic disorder.

Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer. (See section 210.2.)