May 05, 2022

CMS Releases Instructions to Implement Lung Cancer Screening Policy

The Centers for Medicare and Medicaid Services (CMS) recently released a MLN Matters article MM12691 to notify physicians, hospitals and other providers billing Medicare Administrative Contractors (MACs) of the expansion of lung cancer screening services provided to Medicare patients. Medicare covers lung cancer screening with low-dose computed tomography (LDCT) if all eligibility requirements listed in the National Coverage Determination (NCD) 210.14 are met.

The expansion, effective Oct. 3, closely aligns with the United States Preventive Services Task Force's recommendation. CMS is lowering the minimum age for screening from 55 to 50 years and reducing the smoking history from at least 30 pack-years to at least 20 pack-years.

LDCT Lung Cancer Screening is billed using CPT® 71271, Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s), which replaced HCPCS code G0297 as of Jan. 1, 2021. The code G0296, counseling visit to discuss the need for lung cancer screening using low-dose CT scan (LDCT) (service is for eligibility determination and shared decision making) is still used for the initial counseling and shared decision-making visit required by Medicare. Medicare coinsurance and Part B deductible are waived for this preventive service.

In its recent announcement, CMS instructed MACs to deny claims submitted for beneficiaries that are not between the ages of 50 and 77 (55 and 77 for date of service prior to Feb. 10) at the time the services are rendered. CMS allows HCPCS code G0296 and CPT code 71271 to be billed only if the beneficiary is between the ages of 50 and 77 for claims with a date of service on or after Feb. 10. Billing staff should be alerted of these changes.

CMS indicates in transmittal 11388, that MACs will not search for and adjust LDCT claims with dates of service Feb. 10–Oct. 3, but they will adjust such claims brought to their attention. Providers should monitor claims closely and contact their MAC to rectify errors — or if they have any questions.

This instruction only changes the coverage to expand the age of the beneficiaries eligible for services. It does not change billing procedures that existed under the prior CR9246. Medicare will allow one CPT code 71271 per 12-month period (at least 11 full months must elapse from the date of the last screening). The billing procedures under that CR remain unchanged. Medicare will reimburse CPT 71271 and G0296 when billed with the following ICD-10 diagnosis codes:

For a former smoker:
Z87.891 Personal history of tobacco use/personal history of nicotine dependence

For a current smoker:
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.213 Nicotine dependence, cigarettes, with withdrawal
F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

The American College of Radiology®(ACR®) is seeking clarification about the policy change that will allow the counseling and shared decision-making visit to be furnished by auxiliary personnel “incident to” a physician’s professional service. In the final coverage decision memo released in February, CMS removes the requirement that the counseling and shared decision-making visit must be furnished by a physician or Non-physician Practitioner (NPP).

For additional information about lung cancer screening coverage and reimbursement, please contact Alicia Blakey, ACR Principal Economic Policy Analyst. View the ACR web resource Low-Dose CT Lung Cancer Screening FAQ.