Lung Cancer Screening

Before ordering the LDCT screening test the ordering provider must ensure that all eligibility criteria have been met and documented in the medical record. If the provider answers “no” to any of the criteria below, the patient’s insurance may not cover the exam. In the event that the criteria are not met and the patient would still like to have a lung screening, the exam could be completed as a self-pay. Screening should be discontinued once a person has not smoked for 15 years.

• The patient is asymptomatic (no signs or symptoms of lung cancer).
• The patient is between the ages of 50 – 80 and has a tobacco history of at least 20 pack years.
  • One pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes.
  • Smokingpackyears.com is an easy-to-use online pack year calculator that calculates variations in smoking history.
  • Coverage of screening varies among private insurers and should be verified prior to screening.
  • Current Medicare eligibility criteria are ages 55-77 with 30 pack years.
• The patient currently smokes or quit within the last 15 years.
  • If currently smoking, smoking treatment and counseling must be offered to the patient and documented in the medical record.
    • View the Maine QuitLink Referral Instructions section on this page for more information
    • NOTE: Additional tobacco treatment resources may be available in your region, including individual counseling or group support.
  • If the patient is a former smoker (quit tobacco use within the last 15 years), counseling should be provided on the importance of maintaining cigarette smoking abstinence.
• The patient has had a shared decision making (SDM) conversation with a physician or qualified non-physician practitioner, including the use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure. SDM conversations must be documented in the patient’s medical record.     
  • A qualified non-physician practitioner is a physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the Social Security Act.
  • NOTE: If referring to the MaineHealth Maine Medical Center Lung Cancer Screening Program in Scarborough, the referring provider does not need to conduct the SDM conversation or smoking cessation conversation with the patient as these will be performed as part of the screening.
• The patient does not have a health problem that substantially limits life expectancy or the ability to undergo diagnosis and treatment.
• The patient is willing to undergo diagnosis and treatment, if appropriate.
• The patient has been counseled on the importance of adherence to annual lung cancer LDCT screening.
  
   

Encourage patients to contact their insurance provider regarding coverage. Annual lung cancer screening with LDCT is recommended by the US Preventive Services Task Force (USPSTF) and is generally covered by the Centers for Medicare and Medicaid Services (CMS) and many private health insurance companies for qualified patients.

• Medicare Part B covers lung cancer screening for patients ages 55 – 77 who meet the eligibility criteria. Centers for Medicare & Medicaid Services: Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N)
• Medicaid in both Maine and New Hampshire covers lung cancer screening for patients 55 – 80 who meet the eligibility criteria.

Health Care Common Procedure Coding System (HCPCS) Codes:

• G0296 – Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making)
• G0297 – LDCT for lung cancer screening

ICD-10 Codes

• F17.210, F17.211, F17.213, F17.218, F17.219, Z87.891
  • These are suggested codes, but not an all-inclusive list.

• Centers for Medicare & Medicaid Services: Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N)
• United States Preventive Services Task Force (USPSTF): Lung Cancer: Screening Recommendation
• National Lung Screening Trial (NLST): Reduced lung-cancer mortality with low-dose computed tomographic screening
• MaineHealth Cancer Care
• Maine Lung Cancer Coalition
• Centers for Disease Control and Prevention
• Maine QuitLink
• QuitWorks - New Hampshire
  
   

The Maine QuitLink accepts provider referrals for tobacco treatment services and patients can also self-refer online.

• Maine QuitLink Patient Referral Form