Imaging
Why it's done
What are low-dose CT scans? A low-dose CT scan (LDCT) is the medical imaging modality recommended by specialists (such as the US Preventative Task Force) for lung cancer screening. Low-dose CT scans are a computed tomography technique that uses X-rays to create internal images of your body.
CT is an accurate technique for diagnosis of abdominal diseases like Crohn's disease, GIT bleeding, and diagnosis and staging of cancer, as well as follow-up after cancer treatment to assess response.
During an LDCT scan, you lie on a table and an X-ray machine uses a low dose (amount) of radiation to make detailed images of your lungs.
Medicare Part B (Medical Insurance) covers lung cancer screenings with Low Dose Computed Tomography (LDCT) once per year if you meet all of these conditions: You're age 55-77. You don't have signs or symptoms of lung cancer (asymptomatic).
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 35, §50 Therapeutic Procedures
The Centers for Medicare & Medicaid Services (CMS) has authorized a screening benefit for lung cancer using low dose computed tomography (LDCT) scanning. There are two CPT/HCPCS codes associated with this benefit: G0296 for the initial visit and 71271 for the scan and subsequent intervention. The descriptions for these codes are:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
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And if the confusion surrounding what type of providers wasn’t enough, there is also a LDCT screening coding problem involving ICD-10-CM codes.
The code to use for a SDM visit is G0296 (counseling visit to discuss need for lung cancer screening [LDCT]). This is a 15 minute code with reimbursement of $69.65 in the hospital out- patient setting and $28.64 in a physician’s office. It can be billed on the same day as an E/M visit, provided medical necessity is met.
For subsequent annual lung cancer LDCT screenings, the beneficiary must receive a written order for lung cancer LDCT screening. The written order may be furnished during any appropriate visit with a physician (as defined in Section 1861(r)(1) of the Social Security Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the Social Security Act).
Low dose computed tomography (LDCT) is a chest CT scan performed at settings to minimize radiation exposure compared to a standard chest CT. Screening for lung cancer with LDCT is not currently covered under the Medicare program.
Performs LDCT with volumetric CT dose index (CTDIvol) of ≤ 3.0 mGy (milligray) for standard size patients (defined to be 5’ 7” and approximately 155 pounds) with appropriate reductions in CTDIvol for smaller patients and appropriate increases in CTDIvol for larger patients;
According to the Affordable Care Act, 3 all preventative services that received an A or B grade from the USPSTF must be covered by private insurance at no costs to the consumer. 3 Commercial carriers are required incorporate category A and B recommendations with the plans annual renewal.
National coverage for lung cancer screening has arrived. In February 2015, Centers for Medicare & Medicaid Services (CMS) issued a final coverage policy. Heretofore, screening programs have had varying levels of success in attracting providers and patients alike with the major barrier being lack of reimbursement.
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
08/2015 - The purpose of this Change Request (CR) is to inform contractors that Medicare covers lung cancer screening with low dose computed tomography (LDCT) if all eligibility requirements listed in the National Coverage Determination (NCD) are met. Effective date 02/05/2015. Implementation date: 01/04/2016. ( TN 185 ) (CR9246)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.