Local Coverage Article Billing and Coding

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

A58641

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Contractor Information

Article Information

General Information

Article ID
A58641
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
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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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

Article Guidance

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.

 

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
71271 COMPUTED TOMOGRAPHY, THORAX, LOW DOSE FOR LUNG CANCER SCREENING, WITHOUT CONTRAST MATERIAL(S)
G0296 COUNSELING VISIT TO DISCUSS NEED FOR LUNG CANCER SCREENING USING LOW DOSE CT SCAN (LDCT) (SERVICE IS FOR ELIGIBILITY DETERMINATION AND SHARED DECISION MAKING)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

N/A

Revision History Information

N/A

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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Other URLs
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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