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CMS RVU26D · Effective 2026-10-01

G0101 in Redding

Office / nonfacility

$41.09

Base rate per service

Facility setting

$24.62

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Preventive screening

About G0101: Screening pelvic and clinical breast examination

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.

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.

Where the value comes from

  • Work RVU0.44 · 37%
  • Practice expense (office) RVU0.68 · 57%
  • Malpractice RVU0.07 · 6%

728.7K

Medicare services in 2024 · #180 by national volume

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.

G0101 compared with similar codes

Office rates for Redding, from the same CMS release.

Q0091

Pap collection

Screening specimen

$49.01

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.

99397

Per pm reeval est pat 65+ yr

No office rate

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.

G0123

Screen cerv/vag thin layer

No office rate

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

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for G0101 is $41.29—$0.20 higher than the $41.09 rate in Redding. Both use the same code, release and participation basis.

G0101 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $41.09

  2. Bakersfield

    $41.29

    $0.20 higher than Redding

  3. Chico

    $41.09

    The same base rate than Redding

  4. El Centro

    $41.10

    $0.01 higher than Redding

  5. Fresno

    $41.09

    The same base rate than Redding

  6. Hanford-Corcoran

    $41.09

    The same base rate than Redding

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $43.72

    $2.63 higher than Redding

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, G0101 ranges from $35.41 in Arkansas to $50.32 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Merced

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Modesto

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Napa

    California · G0101

    Office

    $46.75

    Facility

    $26.94

    $5.66 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · G0101

    Office

    $43.41

    Facility

    $25.64

    $2.32 higher than Redding for the office setting.

  • Rest Of California

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · G0101

    Office

    $41.85

    Facility

    $25.37

    $0.76 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · G0101

    Office

    $42.89

    Facility

    $25.41

    $1.80 higher than Redding for the office setting.

  • Salinas

    California · G0101

    Office

    $42.73

    Facility

    $25.31

    $1.64 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · G0101

    Office

    $43.57

    Facility

    $25.59

    $2.48 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · G0101

    Office

    $49.19

    Facility

    $28.00

    $8.10 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · G0101

    Office

    $49.11

    Facility

    $27.92

    $8.02 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · G0101

    Office

    $50.32

    Facility

    $28.64

    $9.23 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · G0101

    Office

    $49.99

    Facility

    $28.32

    $8.90 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · G0101

    Office

    $42.07

    Facility

    $24.95

    $0.98 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · G0101

    Office

    $43.85

    Facility

    $25.59

    $2.76 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · G0101

    Office

    $42.84

    Facility

    $25.32

    $1.75 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · G0101

    Office

    $44.28

    Facility

    $25.82

    $3.19 higher than Redding for the office setting.

  • Stockton

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Vallejo

    California · G0101

    Office

    $46.63

    Facility

    $26.82

    $5.54 higher than Redding for the office setting.

  • Visalia

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Yuba City

    California · G0101

    Office

    $41.09

    Facility

    $24.62

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · G0101

    Office

    $44.85

    Facility

    $27.14

    $3.76 higher than Redding for the office setting.

  • Miami

    Florida · G0101

    Office

    $44.25

    Facility

    $28.61

    $3.16 higher than Redding for the office setting.

  • Chicago

    Illinois · G0101

    Office

    $42.99

    Facility

    $27.89

    $1.90 higher than Redding for the office setting.

  • Manhattan

    New York · G0101

    Office

    $45.74

    Facility

    $28.27

    $4.65 higher than Redding for the office setting.

  • Alaska*

    Alaska · G0101

    Office

    $47.52

    Facility

    $31.51

    $6.43 higher than Redding for the office setting.

  • Alabama

    Alabama · G0101

    Office

    $35.89

    Facility

    $22.74

    $5.20 lower than Redding for the office setting.

  • Arkansas

    Arkansas · G0101

    Office

    $35.41

    Facility

    $22.50

    $5.68 lower than Redding for the office setting.

  • Arizona

    Arizona · G0101

    Office

    $38.71

    Facility

    $24.14

    $2.38 lower than Redding for the office setting.

  • Colorado

    Colorado · G0101

    Office

    $40.86

    Facility

    $24.87

    $0.23 lower than Redding for the office setting.

  • Connecticut

    Connecticut · G0101

    Office

    $42.28

    Facility

    $26.09

    $1.19 higher than Redding for the office setting.

  • Delaware

    Delaware · G0101

    Office

    $39.31

    Facility

    $24.46

    $1.78 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · G0101

    Office

    $41.93

    Facility

    $26.71

    $0.84 higher than Redding for the office setting.

  • Rest Of Florida

    Florida · G0101

    Office

    $39.92

    Facility

    $25.55

    $1.17 lower than Redding for the office setting.

  • Atlanta

    Georgia · G0101

    Office

    $40.62

    Facility

    $25.35

    $0.47 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · G0101

    Office

    $37.74

    Facility

    $24.34

    $3.35 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · G0101

    Office

    $41.87

    Facility

    $24.78

    $0.78 higher than Redding for the office setting.

  • Iowa

    Iowa · G0101

    Office

    $36.41

    Facility

    $22.65

    $4.68 lower than Redding for the office setting.

  • Idaho

    Idaho · G0101

    Office

    $36.70

    Facility

    $22.87

    $4.39 lower than Redding for the office setting.

  • East St. Louis

    Illinois · G0101

    Office

    $40.30

    Facility

    $26.47

    $0.79 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · G0101

    Office

    $39.09

    Facility

    $25.36

    $2.00 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · G0101

    Office

    $42.27

    Facility

    $26.83

    $1.18 higher than Redding for the office setting.

  • Indiana

    Indiana · G0101

    Office

    $36.89

    Facility

    $22.95

    $4.20 lower than Redding for the office setting.

  • Kansas

    Kansas · G0101

    Office

    $36.41

    Facility

    $22.82

    $4.68 lower than Redding for the office setting.

  • Kentucky

    Kentucky · G0101

    Office

    $37.03

    Facility

    $23.67

    $4.06 lower than Redding for the office setting.

  • New Orleans

    Louisiana · G0101

    Office

    $38.73

    Facility

    $24.58

    $2.36 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · G0101

    Office

    $37.04

    Facility

    $23.74

    $4.05 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · G0101

    Office

    $44.50

    Facility

    $26.55

    $3.41 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · G0101

    Office

    $40.71

    Facility

    $24.88

    $0.38 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · G0101

    Office

    $42.19

    Facility

    $26.07

    $1.10 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · G0101

    Office

    $39.97

    Facility

    $24.76

    $1.12 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · G0101

    Office

    $37.05

    Facility

    $23.22

    $4.04 lower than Redding for the office setting.

  • Southern Maine

    Maine · G0101

    Office

    $38.68

    Facility

    $23.78

    $2.41 lower than Redding for the office setting.

  • Detroit

    Michigan · G0101

    Office

    $40.56

    Facility

    $26.05

    $0.53 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · G0101

    Office

    $38.07

    Facility

    $24.35

    $3.02 lower than Redding for the office setting.

  • Minnesota

    Minnesota · G0101

    Office

    $38.76

    Facility

    $23.29

    $2.33 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · G0101

    Office

    $38.31

    Facility

    $24.19

    $2.78 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · G0101

    Office

    $38.66

    Facility

    $24.35

    $2.43 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · G0101

    Office

    $36.55

    Facility

    $23.60

    $4.54 lower than Redding for the office setting.

  • Mississippi

    Mississippi · G0101

    Office

    $35.98

    Facility

    $23.04

    $5.11 lower than Redding for the office setting.

  • Montana**

    Montana · G0101

    Office

    $39.74

    Facility

    $24.71

    $1.35 lower than Redding for the office setting.

  • North Carolina

    North Carolina · G0101

    Office

    $37.38

    Facility

    $23.36

    $3.71 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · G0101

    Office

    $38.36

    Facility

    $23.33

    $2.73 lower than Redding for the office setting.

  • Nebraska

    Nebraska · G0101

    Office

    $36.54

    Facility

    $22.67

    $4.55 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · G0101

    Office

    $40.39

    Facility

    $24.74

    $0.70 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · G0101

    Office

    $44.47

    Facility

    $27.03

    $3.38 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · G0101

    Office

    $42.65

    Facility

    $26.24

    $1.56 higher than Redding for the office setting.

  • New Mexico

    New Mexico · G0101

    Office

    $38.33

    Facility

    $24.55

    $2.76 lower than Redding for the office setting.

  • Nevada**

    Nevada · G0101

    Office

    $39.38

    Facility

    $24.33

    $1.71 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · G0101

    Office

    $46.98

    Facility

    $29.11

    $5.89 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · G0101

    Office

    $43.06

    Facility

    $26.60

    $1.97 higher than Redding for the office setting.

  • Queens

    New York · G0101

    Office

    $45.85

    Facility

    $28.09

    $4.76 higher than Redding for the office setting.

  • Rest Of New York

    New York · G0101

    Office

    $37.92

    Facility

    $23.64

    $3.17 lower than Redding for the office setting.

  • Ohio

    Ohio · G0101

    Office

    $37.79

    Facility

    $24.07

    $3.30 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · G0101

    Office

    $36.80

    Facility

    $23.37

    $4.29 lower than Redding for the office setting.

  • Portland

    Oregon · G0101

    Office

    $41.90

    Facility

    $25.21

    $0.81 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · G0101

    Office

    $38.96

    Facility

    $23.99

    $2.13 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · G0101

    Office

    $41.39

    Facility

    $25.75

    $0.30 higher than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · G0101

    Office

    $37.76

    Facility

    $23.96

    $3.33 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · G0101

    Office

    $39.96

    Facility

    $24.77

    $1.13 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · G0101

    Office

    $40.52

    Facility

    $25.00

    $0.57 lower than Redding for the office setting.

  • South Carolina

    South Carolina · G0101

    Office

    $37.67

    Facility

    $23.78

    $3.42 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · G0101

    Office

    $38.19

    Facility

    $23.16

    $2.90 lower than Redding for the office setting.

  • Tennessee

    Tennessee · G0101

    Office

    $36.60

    Facility

    $22.94

    $4.49 lower than Redding for the office setting.

  • Austin

    Texas · G0101

    Office

    $40.83

    Facility

    $24.93

    $0.26 lower than Redding for the office setting.

  • Beaumont

    Texas · G0101

    Office

    $37.54

    Facility

    $23.86

    $3.55 lower than Redding for the office setting.

  • Brazoria

    Texas · G0101

    Office

    $39.15

    Facility

    $24.25

    $1.94 lower than Redding for the office setting.

  • Dallas

    Texas · G0101

    Office

    $39.46

    Facility

    $24.49

    $1.63 lower than Redding for the office setting.

  • Fort Worth

    Texas · G0101

    Office

    $39.26

    Facility

    $24.44

    $1.83 lower than Redding for the office setting.

  • Galveston

    Texas · G0101

    Office

    $39.30

    Facility

    $24.38

    $1.79 lower than Redding for the office setting.

  • Houston

    Texas · G0101

    Office

    $40.58

    Facility

    $25.66

    $0.51 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · G0101

    Office

    $38.36

    Facility

    $24.10

    $2.73 lower than Redding for the office setting.

  • Utah

    Utah · G0101

    Office

    $38.15

    Facility

    $24.02

    $2.94 lower than Redding for the office setting.

  • Virginia

    Virginia · G0101

    Office

    $38.67

    Facility

    $23.90

    $2.42 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · G0101

    Office

    $39.96

    Facility

    $24.77

    $1.13 lower than Redding for the office setting.

  • Vermont

    Vermont · G0101

    Office

    $38.36

    Facility

    $23.48

    $2.73 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · G0101

    Office

    $40.58

    Facility

    $24.76

    $0.51 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · G0101

    Office

    $45.21

    Facility

    $26.77

    $4.12 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · G0101

    Office

    $37.18

    Facility

    $22.78

    $3.91 lower than Redding for the office setting.

  • West Virginia

    West Virginia · G0101

    Office

    $37.78

    Facility

    $24.72

    $3.31 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · G0101

    Office

    $39.14

    Facility

    $24.11

    $1.95 lower than Redding for the office setting.

See how rates vary across the country

G0101 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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 all state and territory rates as a table
State / territoryRate 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

Explore G0101 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For G0101 in Redding, the physician’s office rate is $41.09 and the facility-setting rate is $24.62: a difference of $16.47.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for G0101 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$45.20

$41.09 × 110% = $45.20

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0101 in Redding.

PPRRVU2026_Oct_nonQPP.csv

15,083

Code
G0101
Physician work
0.44
Practice expense
0.68
Malpractice
0.07

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for G0101 in Redding
ComponentRVULocality factorAdjusted
Physician work0.44× 1.0170.4475
Practice expense0.68× 1.0960.7453
Malpractice0.07× 0.5360.0375
Total RVUs1.2303
Conversion factor× 33.4009

Office / nonfacility rate, Redding$41.09

Open G0101 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.441.017
Practice expense0.681.096
Malpractice0.070.536

(0.44 × 1.017 + 0.68 × 1.096 + 0.07 × 0.536) × $33.4009 = $41.09

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.441.017
Practice expense0.231.096
Malpractice0.070.536

(0.44 × 1.017 + 0.23 × 1.096 + 0.07 × 0.536) × $33.4009 = $24.62

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

G0101 · Office / nonfacility

$41.09

Effective 2026-10-01

The base rate is $1.91 higher than on 2025-10-01, moving from $39.18 to $41.09 (4.9%).

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

    $39.18changed to$41.09

    • 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 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $39.18

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$41.09$24.62RVU26D
2026-07-01$41.09$24.62RVU26C
2026-04-01$41.09$24.62RVU26B
2026-01-01$41.09$24.62RVU26A
2025-10-01$39.18$26.45RVU25D
2025-07-01$39.18$26.45RVU25C
2025-04-01$39.18$26.45RVU25B
2025-01-01$39.18$26.45RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for G0101PPRRVU2026_Oct_nonQPP.csv, line 15,083 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet