Preventive Services: Lung Cancer Screening &

Lung Cancer Basics Types of lung cancer
Non-small cell
80% to 85%
Small cell
10% to 15%
Other types of lung tumors
Lung carcinoid tumors
Other lung tumors
Cancer that spreads to the lungs<br>

Statistics Second most common
2025 estimates
226,650 new cases
124,730 deaths
Risk factors
Tobacco smoke
Secondhand smoke
Radon
Workplace Causes
Smoking
Environmental factors
Gene changes<br>

Lung Cancer Screening Coverage Criteria<br>

Lung Cancer Screening Covered under Part B
Age 50 to 77
Asymptomatic
Smoking history of at least 20 pack-years
Current smoker or quit within last 15 years
Receive an order
Annually for covered patients
No coinsurance or deductible<br>

National Coverage Determination 210.14 Counseling and shared decision making
Determine patient’s eligibility
Shared decision making
Decision making aids
Counseling on adherence to annual screening
Counseling on stopping smoking
Reading by board certified Radiologist
Eligible radiology imaging facility<br>

Billing for Lung Cancer Screening<br>

Billing/Coding Lung Cancer Screening Coding
G0296
71271
Diagnosis
F17.210
F17.211
F17.213
F17.218
F17.219
Z87.891 Type of bill
12x
13x
22x
23x
71x – G0296 only
77x – G0296 only
85x CPT only copyright 2024 American Medical Association. All rights reserved.<br>

Counseling to Prevent Tobacco Use Coverage Criteria<br>

Counseling to Prevent Tobacco Use Covered under Part B
Beneficiary must use tobacco
Tobacco-related disease not necessary
Patient must be competent and alert
Counseling by qualified physician or another Medicare-recognized practitioner
Two attempts per 12-month period
Four intermediate or intensive sessions
Additional session after 12 months
No coinsurance or deductible<br>

Billing for Counseling to Prevent Tobacco Use<br>

Billing for Tobacco Counseling CPT
99406
99407
Evaluation and Management (E/M)
99201 – 99215
Modifier 25
ICD-10
See the Medicare Claims Processing Manual, Chapter 32, § 12.1 for list CPT only copyright 2024 American Medical Association. All rights reserved<br>

Additional Billing Requirements Type of service = 1
Type of bill
12x
13x
22x
23x
34x
71x
77x
83x
85x Revenue Codes
RHC/FQHC
52x
CAH Method II
96x
97x
98x
All other providers
942<br>

Eligibility<br>

Eligibility Options WPS Secure Net Access Portal (SNAP)
Preventive Services tab shows next eligibility date
HIPAA Eligibility Transaction System (HETS)
271 response file will show next eligibility date<br>

WPS SNAP CPT only copyright 2024 American Medical Association. All rights reserved.<br>

Resources Medicare Preventive Services tool
NCD 210.14 Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
NCD 210.4.1 Counseling to Prevent Tobacco Use
Medicare Claims Processing Manual, Chapter 18, § 220
Medicare Claims Processing Manual, Chapter 32, § 12<br>

Questions and Answers<br>

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Disclaimers This material is a tool to assist the provider community. Medicare rules change often. Access CMS’ website for current coverage, regulations and rulings.
The basis for answers given today rely on facts given in the question. Medicare rules determine final coverage. 
Do not record the event as CMS does not allow this for profit making purposes.<br>

CPT Copyright Notice CPT codes, descriptions, and other data only are copyright 2024 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. 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.<br>

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