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Medicare updates instructions for waiver of LDCT copayment, deductible

The Centers for Medicare and Medicaid Services (CMS) is instructing Medicare Administrative Contractors (MACs) to waive beneficiaries' copayment and deductible obligations when low-dose computed tomography (LDCT) lung cancer screening is provided consistent with the agency's national coverage decision. The previous G-code G0297 used to describe the CT services has been end-dated. The applicable code is now CPT 71271, computed tomography, thorax, low dose for lung cancer screening, without contrast material(s).

Medicare pays for lung cancer screening, counseling, and shared decision-making visits, and for an annual screening for lung cancer with low dose computed tomography as a preventive service benefit under the Medicare program only if all of the following beneficiary criteria are met. The patient must:

  • Be 55 – 77 years old;
  • Be asymptomatic (no signs or symptoms of lung cancer);
  • Have a tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);
  • Be a current smoker or one who has quit smoking within the last 15 years; and
  • Receive a written order for LDCT lung cancer screening.

The MACs are instructed to deny claims for lung cancer screening counseling and shared decision-making visits (HCPCS G0296) and the LDCT (71271) if they are not submitted along with ICD10 codes Z87.891 (personal history of tobacco use/personal history of nicotine dependence), F17.210 (Nicotine dependence, cigarettes, uncomplicated ), F17.211 (Nicotine dependence, cigarettes, in remission), F17.213 (Nicotine dependence, cigarettes, with withdrawal), F17.218 (Nicotine dependence, cigarettes, with other nicotine-induced disorders), or F17.219 (Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders).

Unfortunately, CMS has not yet removed barriers to the performance of LDCT lung cancer screening services by independent diagnostic testing facilities (IDTFs). IDTFs are permitted to perform only diagnostic testing activities. CMS advises that IDTFs may perform the LDCT scan associated with this screening benefit when all requirements for coverage are met. However, CMS advises that 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. CMS states that the physician and IDTF must have a business arrangement for cooperatively providing this portion of the benefit and the IDTF should look to the physician for payment. 

The new transmittal on waiver of copayments and deductible amounts is effective on January 1, 2022. However, the agency states, for claims with dates of service on and after January 1, 2021, the effective date is the date of service.

There is no deductible and no coinsurance for HCPCS codes G0296, G0297 and 71271 claim lines.

Tags

health care & life sciences, medicare, lung cancer screening

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