Providers must meet all coverage criteria to be reimbursed by Medicare. The questions and answers below address coverage and reimbursement requirements relating to patient eligibility, center eligibility, accreditation and lung cancer screening designation, radiologist requirements, clinical practice registry, and billing and payment.
CMS issued a national coverage decision (NCD) on Feb. 5, 2015, announcing a new benefit for low-dose computed tomography (LDCT) lung cancer screening for certain Medicare beneficiaries.
Beginning Jan. 4, 2016, Medicare contractors will accept claims for LDCT lung cancer screening retroactive to the Feb. 5, 2015, date of the NCD.
CMS posted claims billing instructions (Change Request Transmittal 185 and Transmittal 3374) 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.
- Medicare coinsurance and Part B deductible are waived for this preventive service
- Preventive services are non-covered by Medicare unless specifically covered in the NCD, in statute or regulations
The following two new G codes should be used for the shared decision-making visit (G0296) and LDCT lung cancer screening (G0297).
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
Medicare will deny G0296 and G0297 for claims that do not contain ICD-9 code V15.82 (ICD-10 Z87.891, personal history of tobacco use/personal history of nicotine dependence).
CMS will be adding F17.2- (Nicotine dependence) to the approved list of ICD-10 codes on the National NCD 210.14 for low-dose computed tomography (LDCT) lung cancer screening. Providers should be on the lookout for a revised Change Request.
For additional information on lung cancer screening coverage and reimbursement, visit the Lung Cancer Screening Resources page.