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).

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

   • 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.

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 Codes

Z87.891

Frequency

Annually for covered Medicare beneficiaries

   • First year: Before the first lung cancer LDCT screening, Medicare beneficiaries must receive a counseling and shared decision making visit

   • Subsequent years: The Medicare beneficiary must receive a written order furnished during an appropriate visit with a physician or NPP

Medicare Beneficiary Pays

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

   Note: You pay nothing for this service if the primary care doctor or other qualified primary care practitioner meets the appropriate standards and accepts assignment.

References