Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low Dose Computed Tomography (NCD 210.14)
Effective February 5, 2015, Medicare began covering lung cancer screening counseling
and a shared decision making visit, and for appropriate beneficiaries, annual screening for
lung cancer with low dose computed tomography (LDCT). For more information,
refer to http://www.cms.gov/medicarecoverage-database/details/nca-decisionmemo.aspx?NCAId=274 on the Centers for
Medicare & Medicaid Services (CMS) website.This product will be updated with more information as it becomes available.
HCPCS/CPT Codes
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)
G0297 – Low dose CT scan (LDCT) for lung cancer screening
ICD-10-CM (ICD-9-CM) Codes
Report one of the following codes:
Z87.891
Who Is Covered
Medicare covers lung cancer screening with Low Dose Computed Tomography (LDCT) for people with Medicare who meet all of these:
Are age 55-77
They're asymptomatic (they don’t have signs or symptoms of lung cancer)
Are either a current smoker or have quit smoking within the last 15 years
Have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years)
Get a written order from their physician or qualified non-physician practitioner.
Before your first lung cancer screening, you’ll need to schedule an appointment with your doctor to discuss the benefits and risks of lung cancer screening. You and your doctor can decide whether lung cancer screening is right for you.
The service is furnished by an appropriate radiology imaging center and a reading radiologist that meet Medicare standards.
Frequency
Once every 12 months.
Beneficiary Pays
You pay nothing for this service if the primary care doctor or other qualified
primary care practitioner meets the appropriate standards and accepts assignment.