LCD Reference Article Billing and Coding Article

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

A58641

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Source Article ID
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Article ID
A58641
Original ICD-9 Article ID
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Article Title
Billing and Coding: IDTFs and Low Dose CT Scan for Lung Cancer Screening for CPT Code 71271
Article Type
Billing and Coding
Original Effective Date
01/01/2021
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CMS National Coverage Policy

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 35, §50 Therapeutic Procedures

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 18, §220.4 Preventive and Screening Services

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 13, §20.3 Anti-Markup Payment Limitation

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Article Text

The Centers for Medicare & Medicaid Services (CMS) has authorized a screening benefit for lung cancer using low dose computed tomography (LDCT) scanning.  There are two CPT/HCPCS codes associated with this benefit: G0296 for the initial visit and 71271 for the scan and subsequent intervention. The descriptions for these codes are:

  • G0296 - Counseling visit to discuss need for lung cancer screening using LDCT (service is for eligibility determination and shared decision making)

     

  • 71271 - Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)

Independent Diagnostic Testing Facilities (IDTFs) are enrolled for diagnostic testing only and are not permitted to perform therapeutic activities (CMS Internet-Only Manual, Pub 100-04, Chapter 35). IDTFs may perform the LDCT scan associated with this benefit (when all requirements for coverage, including a physician’s order, are met; see Change Request 9246). However, 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. The physician and IDTF must have a business arrangement for cooperatively providing this portion of the benefit and the IDTF shall look to the physician for payment. Physicians billing for a purchased service, such as the CT scan, should be aware of the anti-markup provisions summarized in the CMS Internet Only-Manual 100-04, Chapter 13, Section 20.3.

 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Public Versions
Updated On Effective Dates Status
02/10/2021 01/01/2021 - N/A Currently in Effect You are here

Keywords

  • Dose CT Scan for Lung Cancer Screening
  • IDTFs