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 "Tobacco HelpLine Referral Instructions and Talking Points" 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 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.
  
  

LDCT can be ordered by a practitioner or specialized lung cancer screening program. Written orders for LDCT must be appropriately documented in the patient’s medical record by the ordering provider.

Lung cancer screening is offered at many MaineHealth system and affiliate locations. The referral process may vary by location. 

Refer to the Billing and Insurance Coverage Information section on this page for guidance on billing and coding. 

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 Tobacco HelpLine
• QuitWorks - New Hampshire
  
   

EPIC Providers

• EPIC supports eReferrals directly to evidence-based tobacco treatment to either the Maine Tobacco HelpLine or QuitWorks - New Hampshire; two telephonic quitlines. The eReferral can be made via the Best Practice Advisory pop-up window that displays after entering the patient's tobacco use status. EPIC automatically directs the eReferral to the appropriate quitline based on the patient’s home address.

Non-EPIC Providers

• Maine Tobacco HelpLine: For non-EPIC practices that have not built a referral to the HelpLine in your EMR system, use the fax referral form. A prepopulated fax referral form is highly recommended and can be made available to practices. For more information, contact: Linda Craig, Maine Tobacco HelpLine Program Coordinator at:
• Phone: 207-662-7150 
• Email: CRAIGL1@mainehealth.org
• QuitWorks - New Hampshire: Provider must document in EMR that counseling was given and then use QuitWork’s online referral process.

Starting the conversation:

“Tell me your thoughts about quitting.” Provider listens attentively and demonstrates respect and compassion for the patient experience.

“I care about you and quitting smoking is the most important thing that you can do for your health right now. We would like to connect all of our patients who use tobacco to (Maine Tobacco Helpline or QuitWorks-New Hampshire) to talk about treatment options. I’d like to send a referral through and they will call you in 1-2 days.”

If they say no:

“Okay, I understand that it’s hard to quit. I want you to know that we are here when you are ready. Here is some information about (Maine Tobacco Helpline or QuitWorks-New Hampshire) if you change your mind later.
 

The MaineHealth Lung Screening Task Force has developed patient outreach and education materials to support lung cancer screening. Click here to view and order these materials for use in your practice.