Revised Medicare Guidelines For Lung Cancer Screening Using LDCT

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Revised Medicare Guidelines For Lung Cancer
Screening Using LDCT
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Revised Medicare Guidelines For Lung Cancer
Screening Using LDCT

• CMS Announcement for Revised Coverage
• The Centers for Medicare and Medicaid Services
  (CMS) has announced a shift in its eligibility
  criteria for coverage of lung cancer screening
  using low-dose CT (LDCT), with implementation
  date of October 3rd, 2022. In addition, CMS also
  made other modifications to its eligibility
  criteria that will increase the ability of more
  people to obtain access to screening, effective
  February 10, 2022. The changes in National
  Coverage Determination (NCD) are as follows
• CMS expanded patient eligibility for screening
  for lung cancer with low dose computed tomography
  (LDCT), including lowering the minimum age for
  screening
• CMS also removed the restriction that a physician
  or non-physician practitioner must provide the
  counseling and shared decision-making (SDM)
• CMS removed the requirement that facilities
  participate in a registry
• Basics of Low Dose Computed Tomography (LDCT)
• The only recommended screening test for lung
  cancer is LDCT. Its a unique CT scan technique
  that combines special x-ray equipment with
  sophisticated computers to produce multiple,
  cross-sectional images or pictures of the inside
  of the body. CMS made the policy changes,
  effective February 10, 2022

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Revised Medicare Guidelines For Lung Cancer
Screening Using LDCT

• Expanded patient eligibility for screening for
  lung cancer with LDCT to closely align with the
  U.S. Preventive Services Task Force
  recommendation
• Lowered the minimum age for screening from 55 to
  50 years and reduced the smoking history from at
  least 30 pack-years to at least 20 pack-years
• Simplified the requirements for the counseling
  and SDM visit
• Removed the restriction that a physician or
  non-physician practitioner must provide the
  counseling and SDM
• Reduced the eligibility criteria for the reading
  radiologist
• Reduced the radiology imaging facility
  eligibility criteria (including removing the
  requirement that facilities participate in a
  registry).
• With these changes, Medicare
• Will allow you to bill codes G0296 and 71271 for
  patients between the ages of 50 and 77 for claims
  with a date of service on or after February 10,
  2022
• Wont search for and adjust LDCT claims with
  dates of service February 10, 2022 October 3,
  2022, but theyll adjust such claims that you
  bring to their attention.
• Beneficiary Eligibility Criteria
• For purposes of Medicare coverage of lung cancer
  screening with LDCT, beneficiaries must meet all
  of the following eligibility criteria

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Revised Medicare Guidelines For Lung Cancer
Screening Using LDCT

• Age 55 77 years
• Asymptomatic (no signs or symptoms of lung
  cancer)
• Tobacco smoking history of at least 30 pack-years
  (one pack-year smoking one pack per day for one
  year 1 pack 20 cigarettes)
• Current smoker or one who has quit smoking within
  the last 15 years and
• Receive a written order for lung cancer screening
  with LDCT. Written orders for lung cancer LDCT
  screenings must be appropriately documented in
  the beneficiarys medical records, and must
  contain the following information
• Beneficiary date of birth
• Actual pack year smoking history (number)
• Current smoking status, and for former smokers,
  the number of years since quitting smoking
• Statement that the beneficiary is asymptomatic
  (no signs or symptoms of lung cancer) and
• National Provider Identifier (NPI) of the
  ordering practitioner.
• Reading Radiologist Eligibility Criteria
• For purposes of Medicare coverage of lung cancer
  screening with LDCT, the reading radiologist must
  meet all of the following eligibility criteria
• Board certification or board eligibility with the
  American Board of Radiology or equivalent
  organization
• Documented training in diagnostic radiology and
  radiation safety
• Involvement in the supervision and interpretation
  of at least 300 chest computed tomography
  acquisitions in the past 3 years

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Revised Medicare Guidelines For Lung Cancer
Screening Using LDCT

• Documented participation in continuing medical
  education in accordance with current American
  College of Radiology standards and
• Furnish lung cancer screening with LDCT in a
  radiology imaging facility that meets the
  radiology imaging facility eligibility criteria.
• Radiology Imaging Facility Eligibility Criteria
• For purposes of Medicare coverage, lung cancer
  screening with LDCT must be furnished in a
  radiology imaging facility that meets all of the
  following eligibility criteria
• Performs LDCT with volumetric CT dose index
  (CTDIvol) of 3.0 mGy (milligray) for standard
  size patients (defined to be 5' 7" and
  approximately 155 pounds) with appropriate
  reductions in CTDIvol for smaller patients and
  appropriate increases in CTDIvol for larger
  patients
• Utilizes a standardized lung nodule
  identification, classification and reporting
  system
• Makes available smoking cessation interventions
  for current smokers and
• Collects and submits data to a CMS-approved
  registry for each LDCT lung cancer screening
  performed.
• Medisys Data Solutions is a leading medical
  billing company providing complete assistance in
  medical billing and coding for your practice. If
  you need any assistance in billing for Medicare,
  contact us at info_at_medisysdata.com/ 302-261-9187

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