Compliance Focus
Screening Pelvic Examinations
For billing purposes, Medicare patient visits for screening pelvic exams require at least seven of the following required eleven
examination elements:
• Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge;
• Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses;
• External genitalia (for example, general appearance, hair distribution, or lesions);
• Urethral meatus (for example, size, location, lesions, or prolapse);
• Urethra (for example, masses, tenderness, or scarring);
• Bladder (for example, fullness, masses, or tenderness);
• Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele);
• Cervix (for example, general appearance, lesions or discharge)
• Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support);
• Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity); and
• Anus and perineum.
When at least seven of the 11 examination elements are documented, and other coverage parameters are met, Medicare Part B will pay for screening pelvic examinations.
For a complete summary of the Medicare coverage and billing requirements for Screening Pelvic Examinations or if you have any questions please call or e-mail Neil Walsh in the Billing Compliance Department at 617-732-9377 or cwalsh6@partners.org