When a pap smear MAY NOT be claimed
In accordance with Rule of Application 17, tariff 9795 Taking of cytological smears for cancer screening MAY NOT be claimed in addition to the following visit services:
- Family Practice tariffs 8498/99, 8470/71, 8420/21, 8422/23, 8450/60 and 8451/61;
- Paediatrics tariffs 8498/99 and 8470/71; and
- Obstetrics & Gynaecology tariffs 8540/8495 and 8496/97.
Each of these tariffs represents a specific type of visit service which includes a Gynaecological Examination. For statistical monitoring purposes, one tariff in each of the listed pairs includes the taking of cytological smears for cancer screening, and the other tariff specifically excludes the taking of such smears.
Note: As is also specified in Rule of Application 17, one of the components of a Gynaecological Examination is a comprehensive pelvic examination which is comprised of the following elements:
- Performance of visual inspection of the vulva and perineum;
- Insertion of a speculum into the vagina to inspect the vault and cervix;
- Bimanual examination of the uterus and ovaries; and
- Conduction of a pelvi-rectal examination (where indicated).
When a pap smear MAY be claimed
Where a pap smear is taken as part of a visit or consultation service other than those listed above, tariff 9795 may be claimed in addition to the service.
Some examples of when such an additional claim may be made are:
- Pre/post-natal care visits – Tariff 9795 may be claimed in addition to tariff 8400 Comprehensive pre-natal assessment or tariffs 8401/8402 Pre/post natal visits.
- Consultation – Tariff 9795 may be claimed in addition to tariff 8550Consultation.
- In a situation where not all elements of a comprehensive pelvic examinations noted above are performed, but a pap smear is taken, the appropriate visit tariff which does NOT include a Gynaecological Examination (e.g., tariff 8529 or 8540 for Family Physicians/Paediatricians and tariffs 8505 or 8530 for Gynaecologists) should be claimed, in addition to tariff 9795.
- Tariff 9795 may be claimed in addition to any consultation or visit service rendered by a physician who does not claim from the Family Practice, Paediatrics or Obstetrics & Gynaecology visit pages.
Updated: April 2017