Summary & Overview
HCPCS Q0113: Pinworm Examinations
HCPCS Level II code Q0113 designates pinworm examinations, a diagnostic service used to detect Enterobius vermicularis infection. As pinworm infection remains a common parasitic condition, accurate coding for focused examinations is important for clinical documentation, billing consistency, and public health reporting. This code captures the targeted diagnostic encounter rather than treatment.
Key national payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical purpose, typical sites of service, and the payer landscape that affects coverage and claims handling. The publication outlines common billing considerations, expected use cases in ambulatory and pediatric settings, and where to find guidance on documentation to support medical necessity.
The report also summarizes benchmarks and policy topics readers should watch: coding and claim submission practices for diagnostic parasitology, differences in coverage across major payers, and implications for outpatient clinics that frequently evaluate pediatric patients. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code Q0113 represents pinworm examinations, a diagnostic clinical service focused on identifying Enterobius vermicularis (pinworm) infection. This procedure typically involves direct inspection of the perianal area, the use of adhesive tape testing (or similar sampling techniques), and microscopic examination of collected specimens to detect ova.
Service Type: Diagnostic examination
Typical Site of Service: Outpatient clinic, pediatric clinic, primary care office, or other ambulatory care settings
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Clinical & Coding Specifications
Clinical Context
A typical patient is a child or household contact presenting to a primary care clinic, pediatric office, community health center, or school-based clinic with symptoms suggesting enterobiasis (pinworm infection), such as perianal itching, irritability at night, or observed worms. The clinical workflow begins with a focused history and physical exam assessing pruritus, nocturnal restlessness, and possible secondary excoriation. For confirmation, the provider performs a perianal pinworm test (eggs collection via adhesive cellophane tape, commonly called the “tape test”) or direct visual inspection of the perianal region; these specimen collection and examination services correspond to the pinworm examination service billed with Q0113. When performed at the point of care, the specimen may be examined in-office by laboratory personnel or prepared for transport to a reference lab. Documentation includes indication, method of collection (eg, tape test), time/date of collection, findings (eg, eggs visualized, motile worms, or negative), and any counseling provided. Typical sites of service are outpatient clinic, pediatrician office, family medicine office, school nurse office, or public health clinic. Treatment decisions (anthelmintic therapy) are documented separately and billed with appropriate office visit or prescription records.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, main service |