$44.01
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.
On this page
CMS RVU26D · Effective 2026-10-01
G0101 Screening pelvic exam Medicare reimbursement rates in Wisconsin
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. Compare G0101 office and facility rates across CMS payment localities in Wisconsin.
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.
What does Medicare pay for G0101 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$37.18
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$22.78
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Wisconsin, from the same CMS release.
99397
No office ratePer pm reeval est pat 65+ yr
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
No office rateScreen cerv/vag 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.
Compare G0101 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
$37.18
Facility
$22.78
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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 Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
15,083
- Code
- G0101
- Physician work
- 0.44
- Practice expense
- 0.68
- Malpractice
- 0.07
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.44 | × 1.000 | 0.4400 |
| Practice expense | 0.68 | × 0.958 | 0.6514 |
| Malpractice | 0.07 | × 0.308 | 0.0216 |
| Total RVUs | 1.1130 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$37.18
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.44 | 1 |
| Practice expense | 0.68 | 0.958 |
| Malpractice | 0.07 | 0.308 |
(0.44 × 1 + 0.68 × 0.958 + 0.07 × 0.308) × $33.4009 = $37.18
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.44 | 1 |
| Practice expense | 0.23 | 0.958 |
| Malpractice | 0.07 | 0.308 |
(0.44 × 1 + 0.23 × 0.958 + 0.07 × 0.308) × $33.4009 = $22.78
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.
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.
15,080G0088,,Adm iv drug 1st home visit,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,081G0089,,Adm subq drug 1st home visit,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,082G0090,,Adm iv chemo 1st home visit,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,083G0101,,Ca screen;pelvic/breast exam,A,,0.44,0.68,,0.23,,0.07,1.19,0.74,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,084G0102,,Prostate ca screening; dre,A,,0.18,0.54,,0.04,,0.01,0.73,0.23,0,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,085G0103,,Psa screening,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,086G0104,,Ca screen;flexi sigmoidscope,A,,0.82,5.50,,0.67,,0.11,6.43,1.60,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,