Screening Services Billed with Evaluation and Management (E&M) Services
Defines when Premera allows screening services (e.g., Pap smear, cervical/vaginal cancer screening, prostate screening) billed on the same date as E&M services and the documentation/modifier requirements; applies to Premera Blue Cross lines of business and affiliates.
No material clinical or coverage changes in this revision.
When screening services can be billed with E&M
Coverage criteria for screening services billed with E&M
Covered when ALL of the following apply:
ALL of the following
Screening services billed alone
- Screening Papanicolaou smear (Q0091) billed alone is allowed.
- Cervical or vaginal cancer screening with pelvic and clinical breast exam (G0101) billed alone is allowed.
- Prostate cancer screening with digital rectal exam (G0102) billed alone is allowed.
Same‑day billing by same provider restrictions
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.