How To Use HCPCS Code G0297

HCPCS code G0297 describes a low dose CT scan (LDCT) for lung cancer screening. This code is used to identify and bill for the specific procedure of performing a LDCT scan for the purpose of screening individuals who are at high risk for developing lung cancer. In this article, we will explore the details of HCPCS code G0297, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0297?

HCPCS code G0297 is a specific code used to identify and bill for a low dose CT scan (LDCT) for lung cancer screening. It is important to note that this code is only applicable for the purpose of lung cancer screening and not for diagnostic purposes. The LDCT scan is a non-invasive imaging procedure that uses a low dose of radiation to create detailed images of the lungs. It is primarily used to detect early signs of lung cancer in individuals who are at high risk for developing the disease.

2. Official Description

The official description of HCPCS code G0297 is “Low dose CT scan (LDCT) for lung cancer screening.” The short description is “LDCT for lung ca screen.” This description accurately reflects the purpose and usage of this specific code.

3. Procedure

1. The provider prepares the patient for the LDCT scan by explaining the procedure and obtaining informed consent.
2. The patient is positioned on the CT scanner table, usually lying on their back.
3. The CT scanner takes multiple X-ray images of the lungs from different angles.
4. The images are processed by a computer to create detailed cross-sectional images of the lungs.
5. The radiologist or other qualified healthcare professional interprets the images to identify any abnormalities or signs of lung cancer.
6. A report is generated with the findings and recommendations.

4. When to use HCPCS code G0297

HCPCS code G0297 should be used when performing a low dose CT scan specifically for lung cancer screening. It is important to ensure that the patient meets the eligibility criteria for lung cancer screening as defined by the appropriate guidelines. Typically, individuals who are at high risk for developing lung cancer, such as current or former smokers, are eligible for this screening procedure. It is crucial to review and follow the specific guidelines and requirements set forth by Medicare or other insurance providers to determine the appropriate use of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0297, healthcare providers need to ensure that the necessary documentation is in place to support the medical necessity of the procedure. This may include the patient’s medical history, risk assessment, and any relevant diagnostic test results. It is important to accurately code and document the procedure in the medical record, including the indication for the LDCT scan and the findings. Additionally, providers should follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0297 was added to the Healthcare Common Procedure Coding System on February 05, 2015. It has an effective date of January 01, 2021. As of December 31, 2020, this code has been terminated. The termination of this code indicates that it is no longer valid for use in billing. It is important for medical coders and billers to stay updated on code changes and revisions to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the low dose CT scan for lung cancer screening when specific criteria are met. The coverage for HCPCS code G0297 is determined by carrier judgment, indicated by the coverage code C. The pricing indicator code for this code is 13, which means that the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology. It is important to verify the coverage and reimbursement policies of each individual insurance carrier to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G0297 should be billed:

1. A 55-year-old male with a 30-pack-year smoking history presents for a lung cancer screening LDCT scan as part of a routine screening program.
2. A 65-year-old female with a history of heavy smoking and a family history of lung cancer undergoes a LDCT scan for lung cancer screening as recommended by her primary care physician.
3. A 50-year-old male who recently quit smoking and has a history of asbestos exposure is referred for a LDCT scan to screen for lung cancer.
4. A 60-year-old female with a history of chronic obstructive pulmonary disease (COPD) and a 20-pack-year smoking history undergoes a LDCT scan for lung cancer screening.
5. A 70-year-old male with a history of lung cancer in remission undergoes a follow-up LDCT scan to monitor for any recurrence or new lesions.