Payer PolicyActive
Addendum to the eviCore Imaging Guidelines for Low Dose CT
EVICORE-CARDIOVASCULAR_RADIOLOGY-6ED898B9
EviCore by Evernorth
Effective: March 22, 2021
Updated: January 13, 2026
created · Dec 3, 2025
Policy Summary
This policy covers annual low‑dose CT chest screening without contrast (CPT® 71271) for lung cancer. It is limited to patients aged 50–80 with a ≥20 pack‑year smoking history who currently smoke or quit within the past 15 years, have not had a low‑dose CT in the prior 12 months, and have no health problems that substantially limit life expectancy or the ability/willingness to undergo curative lung surgery; patients outside these criteria are excluded.
Coverage Criteria Preview
Key requirements from the full policy
"Modality restriction: screening specified as Low-Dose CT Chest without contrast (CPTAE 71271)."
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