IDTFs and Screening for Lung Cancer with Low Dose CT Scanning - JF Part B
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.
|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