CPT Codes For Lung Cancer Screening | CPT 71271, G0296, CPT 71250, CPT 71260 & CPT 71270

CTP 71271 is defined as a CPT code for lung cancer screening. CPT code 71271 describes a procedure in which a clinician uses a low-dose computed tomography (LDCT) to screen for lung cancer. CPT 71250, CPT 71260, and CPT 71270 can be used for diagnosing lung cancer, and G0296 for the initial visit.

By screening younger people who have smoked fewer cigarettes for lung cancer, we can save more lives and help healthier lives, and many more people at high risk for lung cancer can benefit from screening.

In addition, asymptomatic high-risk persons are good candidates for screening because they have the best chance of lung screening. 

The CMS publishes rules for the Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System before and after finalizing.

All of these modifications went into effect on January 1, 2022; the Hospital Outpatient Prospective Payment System (HOPPS) data on low-dose CT scan CPT code 71271 is encouraging. 

CTP G297 and CPT 71271 can have the lowest imaging without contrast Ambulatory Payment Classifications (APC). Therefore the payment rate for the CPT code fur lung cancer screening is roughly $83.

The American College of Radiology (ACR) supports CMS’s decision to shift the 71271 CPT code for lung cancer screening to imaging without contrast APC in the second tier.

This second category also has a higher reimbursement rate of $111.19. We expect compensation for the CPT code for lung cancer screening to increase shortly.

Medical centers make a concerted effort to screen for relevant individuals and use quality control methods such as Lung-RADS, which can standardize CT reporting and management guidelines for lung cancer screening. However, this complex program demands more than simply a CT scan.

G0296 & 71271 CPT Code Description

CPT 71271 and HCPCS code G0296 can be billed for the initial appointment, the scan, and the following intervention.

CPT 71271: This CPT code for lung cancer screening is officially described by CPT’s manual as: “Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s).”

G0296: This HCPCS code can be billed for counseling for lung cancer screening and is officially described as: “Counseling visit to discuss the need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making).”

When it comes to lung cancer screening, individuals can obtain a CT scan once a year. Before a patient is qualified for a lung cancer screening, all of the following conditions must meet. G0296 and the 71271 CPT code can be billed if the conditions are met. The patient must sign the waiver form if the exam approves but does not meet the screening standards.

Lung cancer screenings can be performed once a year. CT scans are available for patients. If the exam is permitted, but the patient fails the preliminary tests, they will be required to sign a waiver.

They are at least the insurance company’s minimum age, present or past smokers who quit within the last 15 years, and heavy smokers with at least 30 “pack years” of smoking experience (defined as smoking 30 packs of cigarettes on average over 30 years).

A form signed by a trained medical professional is required.

• NPI Number of Reference Provider 
• A physician’s or other qualified health professional’s written order

Billing Guidelines For Lung Cancer Screening CPT Codes

CTP code 71271 can be reported for screening for lung cancer with low-dose computed tomography of the chest without contrast material.

However, therapeutic activities will not permit Independent Diagnostic Testing Facilities (IDTFs), and enrolment is limited to diagnostic testing alone (source: CMS Internet-Only Manual, Pub 100-04, Chapter 35).

IDTFs may perform the relevant LDCT scan if all coverage conditions are met, such as a doctor’s order (see Change Request 9246). If the IDTF and the doctor agree to work together to provide this benefit element, the IDTF will require reimbursement through a business agreement.

Medicare will fund CPT 71271 and CPT G0296 if the following ICD-10 CM diagnostic codes can present on the claim.

For patients who used to smoke: Personal nicotine dependence and cigarette smoking history (ICD 10 CM Z87.891)

For patients who currently smoke:

• ICD 10 CM F17.210: Nicotine addiction as a result of smoking
• ICD 10 CM F17.211: Nicotine dependence and cigarette smoking

Tobacco use, nicotine addiction, and quitting F17.213 Tobacco use, nicotine addiction, and associated conditions F17.218 Tobacco use, nicotine addiction, and related conditions

F17.219 Tobacco usage, nicotine addiction, and undetected nicotine-related disorders. There is also an issue with ICD-10-CM LDCT screening coding. The confusion created by the various types of service providers is unneeded. 

It leaves a hole for our patients who haven’t yet broken the habit. We are aware of CMS’s plans to integrate the ICD-10 code F17.2 due to our discussions with them (Nicotine Dependence). Although contractors have not yet received official guidance, applications for current smokers will cancel.

The code G0296 indicates an SDM appointment (counseling visit to discuss the need for lung cancer screening (LDCT). This 15-minute code will pay $69.65 in an outpatient hospital setting but just $28.64 at a doctor’s office. 

If there is a medical necessity, billing for an E/M visit on the same day is possible. In this situation, the E/M service charge should be multiplied by 25. E/M service time differs from SDM time. There are no copays to worry about because this is a preventative care benefit.

Chest computed tomography with and without contrast is represented by CPT 71250, CPT 71260, and CPT 71270. These codes can be used for diagnostic purposes for the lung cancer screening CPT code procedure.

CPT 71250: The 71250 CPT code is diagnostic and can be reported for computed tomography without contrast material and is officially described in CPT’s manual as: “Computed tomography, thorax, diagnostic; without contrast material.”

TIP: You can find the billing guide for CPT 71250 here.

CPT 71260: The 71260 CPT code is diagnostic and can be reported for computed tomography with contrast material and is officially described in CPT’s manual as: “Computed tomography, thorax, diagnostic; with contrast material(s).”

TIP: You can find the billing guide for CPT 71290 here.

CPT 71270: The 71270 CPT code is diagnostic and can be reported for computed tomography with contrast material and followed by contrast material(s) and further section. CPT’s manual describes it: “Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections.”

The word “diagnostic” has been added to the new CPT 71250, CPT 71260, and 71270 to differentiate between thorax screening and diagnostic CT scans. CPT 71250, CPT 71250, and CPT 71270 for reporting lung cancer screening will no longer be recommended.

CPT code 32405 refers to excision/resection procedures in which the lungs and pleura will remove. This code can also be used for lung cancer screening.

CPT 32405: The 32405 CPT code is officially described in CPT’s manual as: “Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed.”

The following is the new classification for a lung biopsy conducted under imaging guidance for CPT code 32405: Percutaneous lung or mediastinal core needle biopsy guided by diagnostic imaging.

Despite the RVS Update Committee’s (RUC) recommendations to revise and revalue office and outpatient evaluation and management (E/M) services using CPT coding, many clinicians are concerned about Medicare payment changes owing to budget neutrality adjustments mandated by law.

As a result, a trustworthy physician billing company’s radiology medical billing and coding services are becoming increasingly vital for filing accurate claims and maximizing revenue.

How To Use Modifier 26 And Modifier TC With CPT 71271

The 26 and TC modifiers are specialized coding equipment that should utilize in specific situations. These modifiers can specify billing for the 71271 CPT code for lung cancer screening procedures.

It can become confusing when attempting to recall the many components of a technique and the particular settings in which its use is necessary. To submit clean claims for CPT code 71271 and avoid rejections due to double billing, you must be conversant with modifiers 26 and TC.

Despite having a single CPT code, some services and procedures in procedure coding include two independent aspects: a professional component and a technical component. For example, it is prevalent in diagnostic procedures and services like x-rays, stress testing, catheterizations, etc.

It is possible to pay two separate fees for two different aspects of a process, such as when a facility handles the technical side and a single physician takes the professional side of the screening for lung cancer procedure.

When paying for the same procedure, the hospital adds modifier TC, and the doctor adds modifier 26.

Suppose a doctor performs a service’s professional (supervision, interpretation, report) and technical (equipment, supplies, technical assistance) components. In that case, the global service should record (the procedure code without the TC or 26 modification). 

Is CPT 71271 Covered By Medicare?

The fees are equivalent to the Medicare Physician Fee Schedule. Anyone billing Medicare Part B services at a doctor’s office or imaging center must now charge a flat rate of $147 per service for the 71271 CPT code for lung cancer screening.  

In comparison to the outpatient hospital sector, there was no notable increase. It’s a slight decrease from $150 in 2021.