Lung Cancer Screening

HCPCS/CPT Codes

  • G0296 - Counseling visit to discuss need for lung cancer screening using low dose CT scan
  • G0297 - Low dose CT scan for lung cancer screening (Deleted after 12/31/2020)
  • 71271 - Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) (Effective 1/1/2021)

Frequency

Annually

First year: Before first screening, beneficiary must receive counseling and shared decision making visit (HCPCS G0296)

Subsequent years: Beneficiary must receive written order furnished during appropriate visit with physician or non-physician practitioner. Counseling and shared decision-making optional. If the provider elects to provide counseling in subsequent years, include all counseling requirements indicated below.

Diagnosis Code

F17.210-F17.219 - Nicotine dependence

Z87.891 - Personal history of nicotine dependence

Coverage

Beneficiary must meet all of the following eligibility criteria:

  • Age 50 - 77 years;
  • Asymptomatic (no signs or symptoms of lung cancer);
  • Tobacco smoking history of at least 20 pack-years (1 pack-year = smoking 1 pack per day for 1 year, 1 pack = 20 cigarettes);
  • Current smoker or one who has quit smoking within last 15 years;
  • Written order received for lung cancer screening with low dose computed tomography

Written orders must be documented in medical record and include:

  • Beneficiary date of birth;
  • Actual pack-year smoking history (number);
  • Current smoking status and for former smokers, number of years since quitting smoking;
  • Statement that beneficiary is asymptotic, doesn't show signs or symptoms of lung cancer; and
  • National Provider Identifier (NPI) of ordering practitioner

Counseling Requirements

Before the beneficiary's first lung cancer low dose CT screening, the beneficiary must receive a counseling and shared decision-making visit that meets all of the following criteria and is appropriately documented in the medical record:

  • Determination of beneficiary eligibility including age, absence of signs or symptoms of lung cancer, a specific calculation of cigarette smoking pack-years; and if a former smoker, number of years since quitting
  • Shared decision making, including use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure
  • Counseling on importance of adherence to annual screenings, impact of comorbidities and ability or willingness to undergo diagnosis and treatment
  • Counseling on importance of maintaining cigarette smoking abstinence if a former smoker; or importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions
  • If appropriate, furnishing of a written order for lung cancer screening

Subsequent annual lung cancer low dose CT screenings must include a written order. If the provider or non-physician practitioner elects to provide lung cancer screening counseling for the subsequent screening, all of the criteria from the initial counseling (above) must be documented.

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0297/71271

Resources

Last Updated Mar 20 , 2024