- Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid
- Coverage Criteria and Frequency Limits
- Checking Medicare Eligibility
- Top Tobacco Counseling Claim Errors
- Tobacco Cessation Telehealth Guide
- Overcoming Barriers to Tobacco Counseling
- Tobacco Counseling Documentation
- Clinical Guidelines and Recommendations
- Frequently Asked Questions
- Federally Qualified Health Center
- Rural Health Clinic
- Tobacco and Health Effects
- Benefits of Quitting
- Lung Cancer Screening
- Resources
Preventive Services Guide
Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
Table of Contents
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Coverage Criteria and Frequency Limits
- HCPCS/CPT Coding
- Diagnosis Coding
- Cost Sharing
- Reimbursement
- Related Content
Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
Lung cancer screening uses LDCT i.e., a CT scan with a low dose of radiation, to find lung nodules, some of which may be cancer. People who take part in screening can lower their chances of dying from lung cancer. In general, lung cancer screening is not a single test but a process that must be done correctly under the direction of your doctor(s).
Coverage Criteria and Frequency Limits
Covered annually for patients that meet all of the following criteria:
- Age 50-77 years
- Asymptomatic
- Either a current smoker or has quit smoking within the last 15 years
-
- Tobacco smoking history of at least 20 pack years
- Receive an order from doctor or qualified practitioner
- Must contain the following for both initial and subsequent LDCT visit(s)
- date of birth; actual pack year smoking history (number); current smoking status or number of years since quitting smoking; statement the beneficiary is asymptomatic; NPI of ordering practitioner
- Must contain the following for both initial and subsequent LDCT visit(s)
Initial LDCT
- Beneficiary must receive an order during a lung cancer screening counseling and shared decision making visit (before the initial LDCT visit)
- Determination of beneficiary eligibility
- Shared decision making
- Counseling on the importance of adherence to annual screenings
- Counseling on maintaining cigarette smoking abstinence/cessation
Subsequent LDCT
- Beneficiary must receive an order which may be furnished during any appropriate visit with a physician or qualified nonphysician practitioner
HCPCS/CPT Coding
- 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 does for lung cancer screening, without contrast material(s)
Diagnosis Coding
- ICD-10 Codes
- F17.210, F17.211, F17.213, F17.218, F17.219, Z87.891
Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service, and contact your Medicare Administrative Contractor (MAC) for guidance.
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 220
- CMS IOM Publication 100-03, Medicare National Coverage Determination (NCD) Manual, Chapter 1, Part 4 Section 210.14
- Effective February 2022, expanded lung cancer screening with LDCT coverage after completing a national coverage analysis
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 10/10/2024