Can anyone provide some advice on billing Q0091 for pap collection & specimen handling?

Do you have to add a modifier to the code when you bill it with the Preventive Annual Exam code? For instance, 99396 with Q0091. My understanding was that the Q code was not able to be billed separately. (?)

Experience with reimbursement? I know this is typically used for Medicare; what about commercial payers?

Thanks so much!