Does G0296 require prior authorization?

No, G0296 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0296?

Medicare facility rate: $22.38. Non-facility rate: $28.72. Work RVU: 0.52.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.52

Facility

$22.38

Non-Facility

$28.72

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).

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.

CIGNA-A004 — Preventive Care Services - (A004)

AETNA-CPB-0380 — Lung Cancer Screening

A58641 — Billing and Coding: IDTFs and Low Dose CT Scan for Lung Cancer Screening for CPT Code 71271

Ask Verity about documentation requirements, denial risks, or coverage in your state.