HAP Radiology Billing and Coding Blog

Coverage is Expanded for Lung Cancer Screening Using LDCT

Posted: By Sandy Coffta on February 16, 2022

Coverage is Expanded for Lung Cancer Screening Using LDCTThe Centers for Medicare and Medicaid Services (CMS) has announced a shift in its eligibility criteria for coverage of lung cancer screening using low-dose CT (LDCT), thus joining other payers in adopting recommendations made by the US Preventive Services Task Force (USPSTF).  In addition, CMS made other modifications to its eligibility criteria that will increase the ability of more people to obtain access to screening, effective February 10, 2022 with the posting of its Decision Memo.


Here is a review of the Medicare coverage criteria:


Previous Policy

Revised Policy

Coverage between age 55 and 77 years

Coverage between age 50 and 77 years

Smoking history of 30 pack years

Smoking history of 20 pack years

No signs or symptoms of lung cancer

No signs or symptoms of lung cancer

Current smoker or quit within 15 years

Current smoker or quit within 15 years

Screening follows a counseling and shared decision-making visit

Screening follows a counseling and shared decision-making visit

Written order from a physician for screening

Order from a physician for screening

Reading radiologist must document participation in continuing education

Criterion removed

Facilities must participate in a data registry

Criterion removed

Facilities must make available smoking cessation interventions for current smokers

Criterion removed

Independent Diagnostic Testing Facilities (IDTF) were precluded from LDCT screening

IDTFs may provide screening

Criterion had been removed by CMS

Facilities must use a standardized lung nodule identification and reporting system


None of the procedure (CPT) or diagnosis (ICD) coding for lung cancer screening using LDCT has changed from our previous summary.

View a recording of our webinar 2022 Updates to the MPFS & Radiology  Reimbursement Impact

The American College of Radiology (ACR) has worked with CMS to make these revisions, and the ACR applauded the changes. However, the CMS revised policy stops short of embracing all its recommended changes. The ACR says that CMS “should consider the following steps moving forward:

  • Continue Medicare coverage for older current and former smokers past age 78
  • Continue coverage for beneficiaries who stopped smoking more than 15 years prior
  • Inform future screening improvements by reinstating registry participation requirements
  • Drop the requirement for a shared decision-making session prior to the first screening (a current barrier to care).”

As we reported in July, 2021, many commercial payers adopted the USPSTF guidelines ahead of Medicare, and some offer coverage through age 80 rather than 77. The current list of payers with expanded guidelines now includes:

  • GHI/Emblem
  • Humana
  • Aetna
  • United Healthcare
  • Oxford Health Plan
  • Healthfirst of NY
  • Amerigroup/Wellmed
  • Horizon BCBS of NJ
  • BCBS of Delaware
  • Horizon NJ Health

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Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.


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Topics: low dose CT, radiology, lung cancer screening

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