Mastering LDCT Lung Cancer Screening: Codes 71271 & G0296 Billing Guide

Low-Dose CT Thorax Codes for Lung Cancer Screening

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

• G0296: Initial or subsequent low-dose CT scan for lung cancer screening (Medicare-specific)

Updated Coverage per NCD 210.14 (Effective February 10, 2022)

Eligibility expanded to:

• Age 50-77 years (lowered from 55-77)

• ≥20 pack-years smoking history (lowered from 30 pack-years; 1 pack-year = 1 pack/day for 1 year)

• Current smoker or quit within past 15 years

• Asymptomatic (no signs/symptoms of lung disease)

• Written order received for LDCT screening

Mandatory Written Order Elements (Document in medical record):

• Beneficiary date of birth

• Exact pack-years smoked

• Current smoking status (or years quit if former smoker)

• Statement confirming asymptomatic status

• Ordering practitioner’s NPI

Covered ICD-10 Diagnosis Codes:

Note: F17 codes added in 2016 for current smokers; Z87.891 previously sole option.

Pre-Screening Documentation Requirements (First LDCT only):

• Eligibility verification (age, asymptomatic, pack-years, quit date if applicable)

• Shared decision-making discussion (using decision aids covering benefits, harms, false positives, radiation, overdiagnosis)

• Counseling on annual screening adherence, comorbidities, treatment willingness

• Smoking cessation counseling (abstinence for former smokers; cessation + Medicare tobacco services for current)

Subsequent LDCT Orders:

• Required written order from any appropriate visit (e.g., Annual Wellness Visit, tobacco cessation, E/M)

Facility & Radiologist Eligibility Criteria (CMS Requirements):

Imaging Center Must:

• Use LDCT with CTDIvol ≤3.0 mGy (standard patient: 5’7″, ~155 lbs; adjust for size)

• Employ standardized lung nodule ID/classification/reporting

  

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• Offer smoking cessation interventions

• Submit data to CMS-approved registry

Radiologist Must:

• Board certified/eligible (ABR or equivalent) with diagnostic radiology/radiation safety training

• ≥300 chest CT interpretations supervised in past 3 years

• Document ACR guideline-compliant CME

• Work in compliant radiology facility

Billing Tip: Verify all documentation before claim submission to avoid denials. Use 71271 for commercial payers; G0296 for Medicare.

Billing Examples

1. Medicare Initial Screening (Current Smoker):

   text

   CPT: G0296


   Dx1: F17.210 (Nicotine dependence, uncomplicated)


   Dx2: Z87.891


   Modifiers: None


   Place of Service: 22 (Outpatient)


   Documentation: Order with DOB (52), 25 pack-years, "Current smoker, asymptomatic"


2. Commercial Payer Subsequent Screening (Former Smoker):

   text

   CPT: 71271


   Dx1: F17.211 (In remission)


   Dx2: Z87.891
Modifiers: 25 (if E/M same day)


   Documentation: Order notes "Quit 12 years ago, 22 pack-years, asymptomatic"


3. Annual Follow-Up with Tobacco Counseling:

   
   text

   CPT: G0296 + 99407 (Smoking cessation, 10+ min)


   Dx1: F17.210


   Documentation: Shared decision-making + cessation counseling notes


Claim Denial Troubleshooting Tips

Pro Tip: Pre-audit charts using checklist. Appeal denials within 120 days with full documentation packet.