Skip to main content
HCPCS G0101 · Level II · G code

G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0101

Medicare payment
$39.75
PFS non-facility, national; facility $24.72
Coverage code
D
special coverage instructions apply
Practitioner MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
100
83 hospital outpatient
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS G0101, added in 1998, as "Cervical or vaginal cancer screening; pelvic and clinical breast examination". Under the 2026 physician fee schedule (October release) G0101 carries 0.44 work, 0.68 practice-expense and 0.07 malpractice RVUs, which at $33.4009 per RVU pays $39.75 non-facility and $24.72 facility before the locality adjustment. Qualifying APM participants get $39.95 at $33.5675. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration). G0101 is a primary code for 1 add-on code (G0513). In the NCCI PTP files v323r0 G0101 appears in 2 practitioner pairs as column 2 and 98 as column 1 (most often with 99170, G0337), and in 2 hospital outpatient pairs as column 2 and 81 as column 1. G0101 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. HCPCS record: BETOS M1A (office visits - new); pricing indicator 11; type of service 1 (medical care). Nearby codes: G0102, G0103, G0104, G0105.

G0101 descriptor and code status

The October 2026 HCPCS Level II file describes G0101 as “Cervical or vaginal cancer screening; pelvic and clinical breast examination”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0101 CPT code", G0101 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0101
FieldValue
Short descriptorCa screen;pelvic/breast exam
Added to HCPCS1998-01-01
Last actionN (no maintenance), effective 1998-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryM1A: office visits - new
Type of service1: medical care

Medicare payment for G0101

Under the 2026 physician fee schedule (October release) G0101 carries 0.44 work, 0.68 practice-expense and 0.07 malpractice RVUs, which at $33.4009 per RVU pays $39.75 non-facility and $24.72 facility before the locality adjustment. Qualifying APM participants get $39.95 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0101
ComponentNon-facilityFacility
Work RVU0.440.44
Practice expense RVU0.680.23
Malpractice RVU0.070.07
Total RVUs1.190.74
National payment (CF $33.4009)$39.75$24.72
Qualifying APM participant (CF $33.5675)$39.95$24.84
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator S (Procedure or service, not discounted when multiple), APC 5822 (Level 2 Health and Behavior Services), national unadjusted payment $103.79 with a minimum unadjusted copayment of $0.00.

Medically Unlikely Edits for G0101

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0101 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital12 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for G0101 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0101 is the column-2 (bundled) code in 2 active pairs, 50% of which allow a modifier and the column-1 code in 98 (91% modifier-allowed); 231 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0101 (practitioner)
Column-1 codePairs
99170 (CPT; descriptor licensed by AMA)1
G0337 Hospice evaluation preelecti1
Column-2 codes bundled into G0101 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
57410 (CPT; descriptor licensed by AMA)1
96523 (CPT; descriptor licensed by AMA)1
99202 (CPT; descriptor licensed by AMA)1
99203 (CPT; descriptor licensed by AMA)1
99204 (CPT; descriptor licensed by AMA)1
99205 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0101 is the column-2 (bundled) code in 2 active pairs, 50% of which allow a modifier and the column-1 code in 81 (100% modifier-allowed); 110 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0101 (hospital outpatient)
Column-1 codePairs
99170 (CPT; descriptor licensed by AMA)1
G0337 Hospice evaluation preelecti1
Column-2 codes bundled into G0101 (hospital outpatient)
Column-2 codePairs
57410 (CPT; descriptor licensed by AMA)1
99202 (CPT; descriptor licensed by AMA)1
99203 (CPT; descriptor licensed by AMA)1
99204 (CPT; descriptor licensed by AMA)1
99205 (CPT; descriptor licensed by AMA)1
99211 (CPT; descriptor licensed by AMA)1
99212 (CPT; descriptor licensed by AMA)1
99213 (CPT; descriptor licensed by AMA)1

G0101 is a designated primary code for 1 add-on code (G0513).

Pair counts show exposure, not the answer for one claim. Check G0101 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0101

No current LCD or billing and coding article lists G0101. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on G0101

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0101 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0101 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0101 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0101

What does HCPCS code G0101 describe?

"Cervical or vaginal cancer screening; pelvic and clinical breast examination" (short descriptor "Ca screen;pelvic/breast exam"), in the G section (procedures and professional services, temporary). Added 1998-01-01.

Is G0101 a CPT code?

No. G0101 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0101 CPT code" mean this Level II code.

What does Medicare pay for G0101?

Under the 2026 physician fee schedule (October release) G0101 carries 0.44 work, 0.68 practice-expense and 0.07 malpractice RVUs, which at $33.4009 per RVU pays $39.75 non-facility and $24.72 facility before the locality adjustment. Qualifying APM participants get $39.95 at $33.5675.

Is G0101 an add-on code?

G0101 is a primary code for 1 add-on code (G0513).

How many units of G0101 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0101?

G0101 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.