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. The coverage decision includes details on beneficiary screening eligibility, shared decision- making and counseling visits, written order, radiologist, registry, and imaging center requirements. Learn more »
Lung Cancer Screening Coding Information
- 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)
- 71271— Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
Medicare will deny G0296 and 71271 for claims that do not contain these ICD-10 diagnosis codes:
- Z87.891 for former smokers (personal history of nicotine dependence).
- F17.21 for current smokers (nicotine dependence). See list of Current Smoker Diagnosis Codes.
Note: Medicare coinsurance and Part B deductible are waived for this preventive service. See CMS Transmittal 10906.
For additional information on lung cancer screening coverage and reimbursement, refer to key questions identified below: