The Reading Room

The latest on lung cancer screening reimbursement

by Solomon Banjo

This blog has been updated to reflect the correction in Medicare Lung Cancer Screening RVUs and reimbursement.

November is lung cancer screening awareness month, and with CMS finally releasing its claims billing instructions for low-dose CT (LDCT) lung cancer screening, lung cancer screening advocates have one more thing to be thankful for during this holiday season.

Medicare clarifies timing and cost sharing for lung cancer screening

Starting on January 4, 2016, Medicare contractors will accept claims for LDCT lung cancer screening. Although Medicare contractors will only start processing claims in the new year, they will honor all compliant exams performed on or after the national coverage determination on February 5, 2015.

In what is great news for Medicare beneficiaries, CMS noted that it will waive coinsurance and Part B deductibles for this service. This means that high-risk patients will face no costs when receiving this exam. CMS does note that unless stated in the national coverage decision, statutes, or regulations, preventive services are not covered by Medicare.

CMS to pay for shared decision making and screening exam

CMS also finalized two new G codes for the shared decision making visit (G0296) and the screening examination (G0297). It is important to note that all claims made for these procedures must include the appropriate ICD code for an individual with a personal history of tobacco use/personal history of nicotine dependence.

Medicare Reimbursement Levels for Lung Cancer Screening
and Shared Decision Making in 2016

CPT Code Description Work RVUs 2016 Payment
G0296 Counseling visit to discuss need for lung cancer screening LDCT 0.52 $36.00
G0297 LDCT for lung cancer screening 1.02 $249.00

The imaging leader’s lung cancer screening reading list

It has been almost two years since the United States Preventive Services Taskforce’s (USPSTF) recommendation in favor of LDCT lung cancer screening started the chain of events that has just culminated with Medicare reimbursement for this life saving exam. We have been following these developments closely and have selected a few blog posts that cover everything you need to know about private and public coverage for lung cancer screening.

Make the case for lung cancer screening

Use these ready-to-use, customizable slides to present to your referring physicians about your lung cancer screening program.