HAP Radiology Billing and Coding Blog

Most updates to procedural and diagnosis coding become effective at the beginning of the year, but there are always a few mid-year changes that occur. In recent years, coding has changed to accommodate the COVID-19 public health emergency, and there are a few additions this year as well. Along with those, we’ll also add some reminders about topics that we’ve covered before.

The 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.

While The Centers for Medicare and Medicaid Services (CMS) is considering expansion of coverage for lung cancer screening, a new study shows the effectiveness of early detection in the reduction of lung cancer deaths. Dr. Raja Flores and his colleagues concluded that between 2006 and 2016, lung cancer deaths decreased by about 4% each year. “This decline has been driven by many factors, including smoking cessation, medical therapies, CT screening, and earlier therapeutic interventions,” they reported, and in the conclusion they state that, “our analysis suggests that decreased mortality is also associated with a diagnostic shift from later to earlier stage lung cancer.”

Keeping abreast of the various healthcare rules and regulations from federal and state authorities can sometimes be overwhelming for a practice’s management. Here is a summary of some of the most important regulatory issues to be aware of for next year, along with a few payment policy decisions that are not governmental. The links will take you to our recent articles and other sources that probe each topic in more depth.

Nearly a year passed between the announcement by the Centers for Medicare and Medicaid Services (CMS) that Medicare coverage would be available for low-dose computed tomography (LDCT) lung cancer screening and issuance of the regulations that would allow claims to be submitted.  The patient eligibility requirements and the details for performing the exam were announced in February 2015 but it took the rest of the year before the billing and reimbursement particulars were known.  Finally, Medicare will pay for LDCT procedures performed on and after February 5, 2015 beginning in 2016. A 43-page decision memo from CMS defines in great detail the criteria that must be met by patients, physicians, and imaging centers in order for the scans to be eligible for reimbursement.  Here is a practical summary of the rules for performing and billing these screening services.

The Centers for Medicare and Medicaid Services (CMS) announced that Medicare coverage for lung cancer screening using low-dose CT (LDCT) scans would become effective as of February 5, 2015.  However, according to the American College of Radiology (ACR), we are likely a few months away from publication of the details needed before radiology practices can begin submitting claims to Medicare for these scans.  They recommend that “physicians meeting the coverage criteria should hold all claims for low-dose CT lung cancer screening until further reimbursement instructions are released by CMS.”  The article “College Addresses Lung Cancer Screening Questions” appeared in the February 13^th edition of the ACR’s Advocacy in Action eNews.