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

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 Houston, TX, Medicare pays $40.58 for G0101 in the office and $25.66 when it’s performed in a hospital or facility.

$40.58Office (non-facility)
$25.66Hospital or facility
+2.1%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 Houston, TX
  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 Houston, TX 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. Houston, TX pays $40.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

G0101 in Houston, TX vs other payment areas
  1. Houston, TX · this page$40.58
  2. Austin, TX · Texas$40.83+$0.25
  3. Beaumont, TX · Texas$37.54−$3.04
  4. Brazoria, TX · Texas$39.15−$1.43
  5. Dallas, TX · Texas$39.46−$1.12
  6. Fort Worth, TX · Texas$39.26−$1.32
  7. Galveston, TX · Texas$39.30−$1.28

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

Every other payment area

G0101 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$38.36$24.10
Los Angeles, CACalifornia$43.72$25.94
Washington, DC areaDistrict of Columbia$44.85$27.14
Miami, FLFlorida$44.25$28.61
Chicago, ILIllinois$42.99$27.89
Manhattan, NYNew York$45.74$28.27
AlaskaAlaska$47.52$31.51
AlabamaAlabama$35.89$22.74

G0101 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for G0101 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work0.44× 1.0080.4435
Practice expense0.68× 0.9930.6752
Malpractice0.07× 1.3760.0963
Total RVUs1.2151
Conversion factor× 33.4009

Office rate, Houston, TX$40.58

Office: (0.44 × 1.008 + 0.68 × 0.993 + 0.07 × 1.376) × $33.4009 = $40.58

Facility: (0.44 × 1.008 + 0.23 × 0.993 + 0.07 × 1.376) × $33.4009 = $25.66

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.

Codes related to G0101

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

Codes related to G0101
CodeHow it relatesOffice range, Houston, TX
Often billed with
Q0091Pap collection, screening specimenCollection of the screening Pap specimen, commonly reported at the same visit.$46.33
G0123Pap cytology, cytotechnologist-screened thin layerLaboratory screening cytology using a thin-layer preparation from a specimen collected at the exam.$20.26
G0476HPV screening, high-risk types with PapCervical HPV screening may accompany cytology from the same screening visit.$35.09
G0438Annual wellness visit, initial visit, first AWVInitial annual wellness visit; the screening exam may also be performed at that encounter.$176.61
G0439Annual wellness visit, subsequent visitSubsequent annual wellness visit; the screening exam may also be performed at that encounter.$139.27

How G0101 has changed in Houston, TX

G0101 · Office / nonfacility

$40.58

Effective 2026-10-01

The base rate is $1.67 higher than on 2025-10-01, moving from $38.91 to $40.58 (4.3%).

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

    $38.91changed to$40.58

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $40.51changed to$38.91

    • 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

    $39.85changed to$40.51

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $40.72changed to$39.85

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.65 changed to 0.66
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $41.00changed to$40.72

    • 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
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $40.71changed to$41.00

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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $41.40changed to$40.71

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $40.11changed to$41.40

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.05 changed to 0.08
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $39.34changed to$40.11

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $39.54changed to$39.34

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.59 changed to 0.58
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $39.02changed to$39.54

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.58 changed to 0.59
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $39.16changed to$39.02

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $38.96changed to$39.16

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $38.22changed to$38.96

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.03 changed to 0.05
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $38.21changed to$38.22

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.64 changed to 0.58
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $38.21

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$40.58$25.66RVU26D
2026-07-01$40.58$25.66RVU26C
2026-04-01$40.58$25.66RVU26B
2026-01-01$40.58$25.66RVU26A
2025-10-01$38.91$27.23RVU25D
2025-07-01$38.91$27.23RVU25C
2025-04-01$38.91$27.23RVU25B
2025-01-01$38.91$27.23RVU25A
2024-10-01$40.51$28.49RVU24D
2024-07-01$40.51$28.49RVU24C
2024-04-01$40.51$28.49RVU24B
2024-03-09$40.51$28.49RVU24AR
2024-01-01$39.85$28.02RVU24A
2023-10-01$40.72$28.67RVU23D
2023-07-01$40.72$28.67RVU23C
2023-04-01$40.72$28.67RVU23B
2023-01-01$40.72$28.67RVU23A
2022-10-01$41.00$28.89RVU22D
2022-07-01$41.00$28.89RVU22C
2022-04-01$41.00$28.89RVU22B
2022-01-01$41.00$28.89RVU22A
2021-10-01$40.71$28.50RVU21D
2021-07-01$40.71$28.50RVU21C
2021-04-01$40.71$28.50RVU21B
2021-01-01$40.71$28.50RVU21A
2020-10-01$41.40$29.62RVU20D
2020-07-01$41.40$29.62RVU20C
2020-04-01$41.40$29.62RVU20B
2020-01-01$41.40$29.62RVU20A
2019-10-01$40.11$28.44RVU19D
2019-07-01$40.11$28.44RVU19C
2019-04-01$40.11$28.44RVU19B
2019-01-01$40.11$28.44RVU19A
2018-10-01$39.34$28.77RVU18D
2018-07-01$39.34$28.77RVU18C
2018-04-01$39.34$28.77RVU18B
2018-01-01$39.34$28.77RVU18AR1
2017-10-01$39.54$29.03RVU17D
2017-07-01$39.54$29.03RVU17C
2017-04-01$39.54$29.03RVU17B
2017-01-01$39.54$29.03RVU17A
2016-10-01$39.02$28.57RVU16D
2016-07-01$39.02$28.57RVU16C
2016-04-01$39.02$28.57RVU16B
2016-01-01$39.02$28.57RVU16A
2015-10-01$39.16$28.68RVU15D
2015-07-01$39.16$28.68RVU15C
2015-04-01$38.96$28.53RVU15B
2015-01-01$38.96$28.53RVU15A
2014-10-01$38.22$27.79RVU14D
2014-07-01$38.22$27.79RVU14C
2014-04-01$38.22$27.79RVU14B
2014-01-01$38.22$27.79RVU14A
2013-10-01$38.21$27.30RVU13D
2013-07-01$38.21$27.30RVU13C
2013-04-01$38.21$27.30RVU13B
2013-01-01$38.21$27.30RVU13AR

Price G0101 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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