Key facts for NCD 210.2
- Benefit category
- Screening Pap Smear, Screening Pelvic Exam
- Effective date
- 06/19/2006
- Implemented 06/19/2006
- Transmittal
- Transmittal 48
- Versions published
- 3
- Manual chapter
- 210
- NCD Manual (Pub. 100-03)
TL;DR
NCD 210.2 sets Medicare's national policy for screening pap smears and pelvic examinations for early detection of cervical or vaginal cancer under the benefit category "Screening Pap Smear, Screening Pelvic Exam", effective 06/19/2006 and implemented 06/19/2006. A screening pap smear and related medically necessary services provided to a woman for the early detection of cervical cancer (including collection of the sample of cells and a physician’s interpretation of the test results) and pelvic examination (including… It has been revised 2 times since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
Screening Pap Smear
A screening pap smear and related medically necessary services provided to a woman for the early detection of cervical cancer (including collection of the sample of cells and a physician’s interpretation of the test results) and pelvic examination (including clinical breast examination) are covered under Medicare Part B when ordered by a physician (or authorized practitioner) under one of the following conditions:
• She has not had such a test during the preceding two years or is a woman of childbearing age (§1861(nn) of the Social Security Act (the Act).
• There is evidence (on the basis of her medical history or other findings) that she is at high risk of developing cervical cancer and her physician (or authorized practitioner) recommends that she have the test performed more frequently than every two years.
High risk factors for cervical and vaginal cancer are:
• Early onset of sexual activity (under 16 years of age)
• Multiple sexual partners (five or more in a lifetime)
• History of sexually transmitted disease (including HIV infection)
• Fewer than three negative or any pap smears within the previous seven years; and
• DES (diethylstilbestrol) - exposed daughters of women who took DES during pregnancy.
NOTE: Claims for pap smears must indicate the beneficiary’s low or high risk status by including the appropriate diagnosis code on the line item (Item 24E of the Form CMS-1500).
Definitions
• A woman as described in §1861(nn) of the Act is a woman who is of childbearing age and has had a pap smear test during any of the preceding 3 years that indicated the presence of cervical or vaginal cancer or other abnormality, or is at high risk of developing cervical or vaginal cancer.
• A woman of childbearing age is one who is premenopausal and has been determined by a physician or other qualified practitioner to be of childbearing age, based upon the medical history or other findings.
• Other qualified practitioner, as defined in 42 CFR 410.56(a) includes a certified nurse midwife (as defined in §1861(gg) of the Act), or a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in §1861(aa) of the Act) who is authorized under State law to perform the examination.
Screening Pelvic Examination
Section 4102 of the Balanced Budget Act of 1997 provides for coverage of screening pelvic examinations (including a clinical breast examination) for all female beneficiaries, subject to certain frequency and other limitations. A screening pelvic examination (including a clinical breast examination) 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. Pelvic examination (with or without specimen collection for smears and cultures) including:
• 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).
• Anus and perineum.
This description is from Documentation Guidelines for Evaluation and Management Services, published in May 1997 and was developed by the Centers for Medicare & Medicaid Services and the American Medical Association.
Text reproduced from the CMS Medicare Coverage Database record for NCD 210.2 version 3. View the original on cms.gov.
Revision history
09/2025 - Transmittal 13400 issued September 05, 2025, is being rescinded and replaced by Transmittal 13438, dated September 30, 2025, to add a new attachment to ensure the functionality of the NCD zip URL is working properly and to update the Policy section. All other information remains the same.
The purpose of this Change Request (CR) is to provide a maintenance update of ICD-10 coding changes specific to NCDs. ( TN 13438 ) (CR14197)
08/2025 - The purpose of this Change Request (CR) is to provide a maintenance update of ICD-10 coding changes specific to NCDs. ( TN 13375 ) (CR14197)
10/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 11083 ) (CR12482)
11/2018 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html , along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.( TN 2202 ) (CR11005)
12/2015 - This change request (CR) is the 3rd maintenance update of ICD-10 conversions/updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, & CR9087. Some are the result of revisions required to other NCD-related CRs released separately that included ICD-10 coding. Implementation date: 01/04/2016 Effective date: 10/1/2015. ( TN 1580 ) (CR9252)
08/2015 - This change request (CR) is the 3rd maintenance update of ICD-10 conversions/updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, & CR9087. Some are the result of revisions required to other NCD-related CRs released separately that included ICD-10 coding.
These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 01/04/2016 Effective date: 10/1/2015. ( TN 1537 ) (CR 9252)
05/2014 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/06/2014 Effective date: 10/1/2015. ( TN 1388 ) ( TN 1388 ) (CR 8691)
03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/07/2013 Effective date: 10/1/2015. ( TN 1199 ) ( TN 1199 ) (CR 8197)
03/2006 - Delete coding information. Effective/Implementation date: 06/19/2006. ( TN 48 ) (CR4278)
12/2002 - Section 101 of Benefits Improvement and Protection Act of 2000 (P.L. 106-554) changed the screening frequency from once every three years to once every two years. This section of the manual has not been updated to reflect the change. The conforming regulation at 42 CFR § 410.56 has been updated. Effective date of change 07/01/2001.
03/1998 - Reflected changes mandated by section 4102 of the Balanced Budget Act of 1998 and listed high risk factors for developing cervical or vaginal cancer. Effective date 01/01/1998. (TN 103)
07/1990 - Provided coverage instructions authorized by section 6115 of OBRA 1989. Effective date 07/01/1990. (TN 43)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 210.2
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 210.2
What does NCD 210.2 cover?
A screening pap smear and related medically necessary services provided to a woman for the early detection of cervical cancer (including collection of the sample of cells and a physician’s interpretation of the test results) and pelvic examination (including clinical breast examination) are covered under Medicare Part B when ordered by a physician (or authorized practitioner) under one of the following conditions: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 210.2 take effect?
The current version (3) is effective 06/19/2006, implemented 06/19/2006, published in transmittal 48. CMS lists 3 versions of this NCD.
Does a Local Coverage Determination override NCD 210.2?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.