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

Medicare screening pelvic and clinical breast examination for cervical or vaginal cancer, reported for asymptomatic patients at the covered 12- or 24-month screening interval.

CMS RVU26DEffective Oct 1, 2026One payment locality728.7K Medicare services in 2024

In Puerto Rico, Medicare pays $39.96 for G0101 in the office and $24.77 when it’s performed in a hospital or facility.

$39.96Office (non-facility)
$24.77Hospital or facility
+0.5%vs the national office rate ($39.75)

Check a contract rate as a % of Medicare · G0101 nationwide

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

We’ll open G0101 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What G0101 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Puerto Rico compares for G0101

Across 109 of 109 payment localities, the office rate for G0101 runs from $35.41 in Arkansas to $50.32 in San Benito County, CA. Puerto Rico pays $39.96. The RVUs are the same everywhere; the geographic indexes change the dollars.

G0101 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$39.96
  2. Los Angeles, CA · California$43.72+$3.76
  3. Washington, DC area · District of Columbia$44.85+$4.89
  4. Miami, FL · Florida$44.25+$4.29
  5. Chicago, IL · Illinois$42.99+$3.03
  6. Manhattan, NY · New York$45.74+$5.78
  7. Alaska · Alaska$47.52+$7.56

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

G0101 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$35.89$22.74
ArkansasArkansas$35.41$22.50
ArizonaArizona$38.71$24.14
Bakersfield, CACalifornia$41.29$24.82
Chico, CACalifornia$41.09$24.62
El Centro, CACalifornia$41.10$24.63
Fresno, CACalifornia$41.09$24.62
Hanford, CACalifornia$41.09$24.62

G0101 rates by state

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

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$35.41

$47.52

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
G0101 office rate range by state
State / territoryOffice rate rangeLocalities
AK$47.521
AL$35.891
AR$35.411
AZ$38.711
CA$41.09–$50.3229
CO$40.861
CT$42.281
DC$44.851
DE$39.311
FL$39.92–$44.253
GA$37.74–$40.622
GU$41.871
HI$41.871
IA$36.411
ID$36.701
IL$39.09–$42.994
IN$36.891
KS$36.411
KY$37.031
LA$37.04–$38.732
MA$40.71–$44.502
MD$39.97–$44.853
ME$37.05–$38.682
MI$38.07–$40.562
MN$38.761
MO$36.55–$38.663
MS$35.981
MT$39.741
NC$37.381
ND$38.361
NE$36.541
NH$40.391
NJ$42.65–$44.472
NM$38.331
NV$39.381
NY$37.92–$46.985
OH$37.791
OK$36.801
OR$38.96–$41.902
PA$37.76–$41.392
PR$39.961
RI$40.521
SC$37.671
SD$38.191
TN$36.601
TX$37.54–$40.838
UT$38.151
VA$38.67–$44.852
VI$39.961
VT$38.361
WA$40.58–$45.212
WI$37.181
WV$37.781
WY$39.141

See G0101 in every payment locality

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.

How the rate is built · G0101

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.44

0.44 RVUs× 1.000 GPCI

Practice expense0.68

0.68 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

1.1900

Conversion factor

$33.4009

Medicare rate

$39.75

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

15,083

Code
G0101
Physician work
0.44
Practice expense
0.68
Malpractice
0.07

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for G0101 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.44× 1.0000.4400
Practice expense0.68× 1.0110.6875
Malpractice0.07× 0.9850.0690
Total RVUs1.1964
Conversion factor× 33.4009

Office rate, Puerto Rico$39.96

Office: (0.44 × 1 + 0.68 × 1.011 + 0.07 × 0.985) × $33.4009 = $39.96

Facility: (0.44 × 1 + 0.23 × 1.011 + 0.07 × 0.985) × $33.4009 = $24.77

Open G0101 in the RVU calculator

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.

Place of service · G0101

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$39.75

Non-facility (office)
$39.75
Facility
$24.72

Higher because the practice carries its own overhead.

How G0101 has changed in Puerto Rico

G0101 · Office / nonfacility

$39.96

Effective 2026-10-01

The base rate is $2.00 higher than on 2025-10-01, moving from $37.96 to $39.96 (5.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $37.96changed to$39.96

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.45 changed to 0.44
    • Practice expense RVU 0.66 changed to 0.68
    • Malpractice RVU 0.06 changed to 0.07
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $39.39changed to$37.96

    • Conversion factor 33.2875 changed to 32.3465
    • Malpractice RVU 0.07 changed to 0.06

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $38.75changed to$39.39

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $39.79changed to$38.75

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.65 changed to 0.66
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982
  5. October 1, 2023

    RVU23D

    $39.65changed to$39.79

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984
  6. January 1, 2023

    RVU23A

    $40.28changed to$39.65

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.63 changed to 0.65
    • Malpractice RVU 0.08 changed to 0.07
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $39.92changed to$40.28

    • Conversion factor 34.8931 changed to 34.6062
    • Malpractice RVU 0.06 changed to 0.08

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $40.92changed to$39.92

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.60 changed to 0.63
    • Malpractice RVU 0.08 changed to 0.06
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $39.78changed to$40.92

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.05 changed to 0.08
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $39.01changed to$39.78

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.58 changed to 0.60

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $35.43changed to$39.01

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.59 changed to 0.58
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $31.28changed to$35.43

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.58 changed to 0.59
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $31.39changed to$31.28

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $31.23changed to$31.39

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $30.79changed to$31.23

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.03 changed to 0.05
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $30.33changed to$30.79

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.64 changed to 0.58
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $30.33

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$39.96$24.77RVU26D
2026-07-01$39.96$24.77RVU26C
2026-04-01$39.96$24.77RVU26B
2026-01-01$39.96$24.77RVU26A
2025-10-01$37.96$26.23RVU25D
2025-07-01$37.96$26.23RVU25C
2025-04-01$37.96$26.23RVU25B
2025-01-01$37.96$26.23RVU25A
2024-10-01$39.39$27.32RVU24D
2024-07-01$39.39$27.32RVU24C
2024-04-01$39.39$27.32RVU24B
2024-03-09$39.39$27.32RVU24AR
2024-01-01$38.75$26.88RVU24A
2023-10-01$39.79$27.83RVU23D
2023-07-01$39.65$27.79RVU23C
2023-04-01$39.65$27.79RVU23B
2023-01-01$39.65$27.79RVU23A
2022-10-01$40.28$28.42RVU22D
2022-07-01$40.28$28.42RVU22C
2022-04-01$40.28$28.42RVU22B
2022-01-01$40.28$28.42RVU22A
2021-10-01$39.92$27.97RVU21D
2021-07-01$39.92$27.97RVU21C
2021-04-01$39.92$27.97RVU21B
2021-01-01$39.92$27.97RVU21A
2020-10-01$40.92$29.28RVU20D
2020-07-01$40.92$29.28RVU20C
2020-04-01$40.92$29.28RVU20B
2020-01-01$40.92$29.28RVU20A
2019-10-01$39.78$28.16RVU19D
2019-07-01$39.78$28.16RVU19C
2019-04-01$39.78$28.16RVU19B
2019-01-01$39.78$28.16RVU19A
2018-10-01$39.01$28.49RVU18D
2018-07-01$39.01$28.49RVU18C
2018-04-01$39.01$28.49RVU18B
2018-01-01$39.01$28.49RVU18AR1
2017-10-01$35.43$26.52RVU17D
2017-07-01$35.43$26.52RVU17C
2017-04-01$35.43$26.52RVU17B
2017-01-01$35.43$26.52RVU17A
2016-10-01$31.28$23.96RVU16D
2016-07-01$31.28$23.96RVU16C
2016-04-01$31.28$23.96RVU16B
2016-01-01$31.28$23.96RVU16A
2015-10-01$31.39$24.04RVU15D
2015-07-01$31.39$24.04RVU15C
2015-04-01$31.23$23.92RVU15B
2015-01-01$31.23$23.92RVU15A
2014-10-01$30.79$23.60RVU14D
2014-07-01$30.79$23.60RVU14C
2014-04-01$30.79$23.60RVU14B
2014-01-01$30.79$23.60RVU14A
2013-10-01$30.33$22.95RVU13D
2013-07-01$30.33$22.95RVU13C
2013-04-01$30.33$22.95RVU13B
2013-01-01$30.33$22.95RVU13AR

Price G0101 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

G0101 billing questions

How is this code billed alongside a preventive visit such as 99397 for a Medicare patient?

Traditional Medicare does not cover the routine preventive medicine visit described by 99397. Report G0101 for the eligible screening pelvic and breast exam, and Q0091 if a screening Pap specimen is collected; avoid counting those services twice in any separately billed visit.

Does this code include obtaining the Pap smear?

No. Collecting and conveying the screening Pap specimen to the laboratory is reported separately with Q0091. Screening cytology is a separate laboratory service.

What documentation supports the exam?

The record should document the clinical breast exam and at least 7 of the 11 CMS-listed examination elements. It should also support screening intent and any high-risk status used for annual eligibility.

Can a problem-oriented E/M be billed on the same date?

Yes, if the clinician performs a significant, separately identifiable evaluation and management of a problem beyond the screening exam. Append modifier 25 to the E/M code, and do not count the screening work toward that service.

When does the annual frequency apply instead of every 24 months?

The 12-month interval applies with documented high-risk factors for cervical or vaginal cancer, or when a patient of childbearing age had an abnormal Pap result in the preceding 3 years. The claim should include a diagnosis supporting the qualifying status.

Can it be billed for a patient who has had a hysterectomy?

Yes, when an eligible screening pelvic and breast exam is performed, including screening for vaginal cancer after hysterectomy. The applicable screening interval still governs coverage.

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

Show the CMS file lines behind this rate
RVUs for G0101PPRRVU2026_Oct_nonQPP.csv, line 15,083 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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