The Centers for Medicare & Medicaid Services (CMS) has authorized a screening benefit for lung cancer using low dose computed tomography (LDCT) scanning. There are two CPT/HCPCS codes associated with this benefit: G0296 for the initial visit and 71271 for the scan and subsequent intervention. The descriptions for these codes are:
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G0296 – Counseling visit to discuss need for lung cancer screening using LDCT (service is for eligibility determination and shared decision making)
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71271 – Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
Independent Diagnostic Testing Facilities (IDTFs) are enrolled for diagnostic testing only and are not permitted to perform therapeutic activities (CMS Internet-Only Manual, Pub 100-04, Chapter 35). IDTFs may perform the LDCT scan associated with this benefit (when all requirements for coverage, including a physician’s order, are met; see Change Request 9246). However, since the code 71271 also includes a therapeutic activity (smoking cessation interventions must be made available for current smokers), this service must be billed by a physician. The physician and IDTF must have a business arrangement for cooperatively providing this portion of the benefit and the IDTF shall look to the physician for payment. Physicians billing for a purchased service, such as the CT scan, should be aware of the anti-markup provisions summarized in the CMS Internet Only-Manual 100-04, Chapter 13, Section 20.3.