G0296, Counseling visit to discuss need for lung cancer screening using low dose ct
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.52
Facility
$22.38
Non-Facility
$28.72
Documentation Required
- A physician's order is required for an IDTF to perform the LDCT lung cancer screening (71271).
- Documentation of the counseling/shared decision-making visit (G0296) is required to support eligibility determination and shared decision making for screening.
- A documented business arrangement between the physician and the IDTF is required to cooperatively provide the benefit and to clarify payment responsibilities.
- Document patient age and exact smoking history including pack-year calculation (number of packs per day × years smoked) and date of smoking cessation (to confirm 'quit within past 15 years' where applicable).
Key Coverage Criteria
- Low-dose CT (LDCT) of the thorax without contrast (CPT 71271) is covered as the CMS-authorized lung cancer screening scan.
- Counseling and eligibility/shared decision-making visit (HCPCS G0296) is covered to determine eligibility and provide shared decision making for LDCT lung cancer screening.
- Independent Diagnostic Testing Facilities (IDTFs) may perform the LDCT scan (71271) when all Medicare coverage requirements are met, including receipt of a physician's order.
- ICD-10 code Z12.2 (Encounter for screening for malignant neoplasm of respiratory organs) — covered if selection criteria are met.
- ICD-10 code Z72.0 (Tobacco use [former smokers ages 50-80 years]) — covered if selection criteria are met.
- ICD-10 code Z87.891 (Personal history of nicotine dependence [former smokers ages 50-80 years]) — covered if selection criteria are met.
3 Active Policies
A58641, Billing and Coding: IDTFs and Low Dose CT Scan for Lung Cancer Screening for CPT Code 71271
AETNA-CPB-0380, Lung Cancer Screening
CIGNA-A004, Preventive Care Services
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.