IDTFs and Screening for Lung Cancer with Low Dose CT Scanning

CMS has authorized a screening benefit for lung cancer using low dose CT scanning. There are two codes associated with this benefit: G0296 for the initial visit and G0297 for the scan and subsequent intervention.

Code Description
G0296 Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making)
G0297 Low dose CT scan (LDCT) for lung cancer screening

IDTFs are enrolled for diagnostic testing only and are not permitted to perform therapeutic activities (IOM 100-04, Chapter 35). IDTFs may perform the low dose CT scan associated with this benefit (when all requirements for coverage, including a physician's order, are met; see Change Request 9246), however, since the code G0297 also includes a therapeutic activity (must make available smoking cessation interventions for current smokers), this service must be billed by a physician. The physician and IDTF must have a business arrangement for cooperatively providing this portion of the benefit and the IDTF shall look to the physician for payment. Physicians billing for a purchased service, such as the CT scan, should be aware of the anti-mark-up provisions summarized in the Internet Only Manual 100-04 (Claims), Chapter 13 (Radiology), Section 20.3 (Anti-Markup Payment Limitation).

Beginning January 1, 2018, Noridian will no longer pay IDTFs directly for this service.

Effective: January 1, 2018

Last Updated Fri, 24 Aug 2018 15:12:41 +0000