Screening Pelvic Examinations

40 - Screening Pelvic Examinations (Rev. 1541, Issued: 06-20-08, Effective: 09-23-08, Implementation: 09-23-08) Section 4102 of the BBA of 1997 (P.L. 105-33) amended §1861(nn) of the Act (42 USC 1395X(nn)) to include Medicare Part B coverage of screening pelvic examinations (including a clinical breast examination) for all female beneficiaries for services provided January 1, 1998 and later. Effective July 1, 2001, the Consolidated Appropriations Act of 2001 (P.L. 106-554) modifies §1861(nn) to provide Medicare Part B coverage for biennial screening pelvic examinations. A screening pelvic examination with or without specimen collection for smears and cultures, should include at least seven of the following eleven elements: • Inspection and palpation of breasts for masses or lumps, tenderness, symmetry, or nipple discharge; • Digital rectal examination including sphincter tone, presence of hemorrhoids, and rectal masses; • External genitalia (for example, general appearance, hair distribution, or lesions); • Urethral meatus (for example, size, location, lesions, or prolapse); • Urethra (for example, masses, tenderness, or scarring); • Bladder (for example, fullness, masses, or tenderness); • Vagina (for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, or rectocele); • Cervix (for example, general appearance, lesions or discharge) • Uterus (for example, size, contour, position, mobility, tenderness, consistency, descent, or support); • Adnexa/parametria (for example, masses, tenderness, organomegaly, or nodularity); and • Anus and perineum.