The guideline for LDCT lung cancer screening reimbursement for older adults have changed in recent years. In late 2021 and early 2022, both the U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) updated their reimbursement criteria, expanding the age range and smoking history requirements so that more adults can address potential concerns sooner.
As a radiology practice, this is important news for how you deliver your services and submit them for reimbursement. Learn more about you need to know with Healthcare Administrative Partners.
CMS and USPSTF's Lung Cancer Screening Criteria
While historically, Medicare and Medicaid guidelines have set the pace for various changes in eligibility, billing and coding, this modification was unique in that most commercial insurance providers adapted to these changes prior to Medicare acceptance. The result is that most commercial providers have similar slightly different eligibility requirements from Medicare and Medicaid. The criteria for LDCT lung cancer screening state that adults must:
- Be between 50-80 years old (USPSTF) or 50-77 (CMS)
- Be asymptomatic for lung cancer (they display no signs or symptoms)
- Have a history of smoking tobacco that is the equivalent of of greater than 20-pack years (pack-years refer to the number of packs smoked per day multiplied by the number of years smoked)
- Be a current cmoker or have quit smoking in the last 15 years
- Complete the required counseling to qualify for services, if a Medicare beneficiary
Low-Dose CT Lung Cancer Screening Coding
The USPSTF's new criteria were established in mid-2021, and by February of 2022, Medicare responded with its own guideline for beneficiaries. What does all of this mean for LDCT billing and coding?
Most importantly, coders should know that CPT codes 71250-71270 and HCPCS code G0297 are no longer accepted as lung cancer screening codes. As of 2021, the codes you need to know are:
- HCPCS G0296: LDCT screening counseling
- CPT 71271: LDCT screening with contrast
For Medicare LDCT screening, CPT 71271 and G0296 should be reported with Z12.2, which encompasses an encounter for screening for malignant neoplasm of respiratory organs AND a code for smoking history or dependence, such as the ones blow:
- Former smoker: Z87.891 (history of nicotine dependence)
- Current cigarette smokers: F17.210 (uncomplicated), F17.211 (in remission), F17.223 (with withdrawal), F17.218 (with other nicotine-induced disorders), F17.219 (with unspecified nicotine-induced disorders)
Maximize Lung Cancer Screening Revenue With HAP USA
As standards continue to evolve, Healthcare Administrative Partners will continue to be your source of the latest CPT® coding updates. Subscribe to our blog to stay informed, or contact us fore more information about our services.
® Current Procedural Terminology (CPT) is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.
* ICD stands for International Classification of Diseases, the system owned and copyrighted by the World Health Organization that is used to report diagnoses when submitting claims for reimbursement of physician services, among many other purposes. ICD-10 is the 10th edition of this coding system. CM stands for the Clinical Modification of the classification system.
Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.
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