HCPCS code G0101: Screening pelvic exam, pelvic and clinical breast exam2026 Medicare rate & RVUs

Medicare pays $39.75 for G0101 nationally in the office and $24.72 in a hospital or facility. Local office rates run $35.41–$50.32.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What G0101 covers

G0101 covers the hands-on pelvic and clinical breast examination furnished under Medicare's cervical and vaginal cancer screening benefit. Gynecologists, family physicians, internists, nurse practitioners, physician assistants, and certified nurse-midwives commonly perform it in office settings. The exam may occur during a well-woman appointment or alongside a Medicare annual wellness visit. Obtaining a screening Pap specimen is reported separately with Q0091 when that service is performed.

Medicare covers the screening exam every 24 months for most beneficiaries and every 12 months for patients at high risk for cervical or vaginal cancer, or of childbearing age with an abnormal Pap result in the preceding 3 years. Document the clinical breast exam and at least 7 of CMS's 11 specified examination elements, which include the breast, pelvic structures, anus and perineum, and digital rectal exam. The record and diagnosis coding should support screening intent and any claimed annual eligibility. The Part B deductible and coinsurance are waived for this screening service.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where G0101 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

G0101 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the G0101 rate is calculated

Each of G0101’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for G0101

G0101 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

G0101 compared with similar codes

How to choose

Q0091Pap collectionScreening specimen

Q0091 covers collection and conveyance of a screening Pap specimen; G0101 covers the pelvic and clinical breast examination. Both may be reported when both services are performed.

99397Preventive examEstablished patient, age 65+

99397 describes a comprehensive preventive medicine visit, which traditional Medicare does not cover as a routine physical. G0101 identifies the eligible screening pelvic and breast exam when performed, not the entire preventive visit.

G0123Pap cytologyCytotechnologist-screened thin layer

G0123 covers laboratory screening cytology using an automated thin-layer preparation. G0101 covers the clinician's screening pelvic and breast examination, not laboratory testing.

Codes related to G0101

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates