December 31, 2015

LDCT Lung Cancer Screening Billing Instructions

Beginning Jan. 4, 2016, Medicare contractors will accept claims for low-dose computed tomography (LDCT) lung cancer screening retroactive to the date of the national coverage determination (NCD) (Feb. 5, 2015). The Centers for Medicare and Medicaid Services (CMS) posted claims billing instructions (Change Request Transmittal 1 and Transmittal 2) for lung cancer screening with low-dose computed tomography, including details on beneficiary screening eligibility, shared decision making and counseling visits, written order, radiologist, registry and imaging center requirements. CMS has clarified that Medicare coinsurance and Part B deductible are waived for this preventive service. CMS further states that unless specifically covered in the NCD, in statute or regulations, preventive services are non-covered by Medicare.
The following two new G codes should be used for the shared decision-making visit (G0296) and LDCT lung cancer screening (G0297). Note that Medicare will deny G0296 and G0297 for claims that do not contain ICD-9 code V15.82 (prior to Oct. 1, 2015), or ICD-10 Z87.891 (on or after Oct. 1, 2015) for personal history of tobacco use/personal history of nicotine dependence.*

G0296 — Counseling visit to discuss need for lung cancer screening (LDCT) using low-dose CT scan (service is for eligibility determination and shared decision making)
G0297— Low-dose CT scan (LDCT) for lung cancer screening

Questions regarding the CMS claims billing instructions can be sent to the ACR at

*In response to an ACR request, CMS agreed to add ICD-10 code F17.2- (Nicotine dependence) to the approved list of ICD-10 codes on NCD 210.14 for LDCT lung cancer screening at its next earliest opportunity. Providers should be on the look-out for a revised change request.

Reference: CMS to Update NCD for LDCT Lung Cancer Screening, Advocacy-in- Action eNews, December 18, 2015