Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCT

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT): 

HCPCS/CPT Codes

ICD-10 Codes

F17.210, F17.211, F17.213, F17.218, F17.219, Z87.891

Who Is Covered

Medicare beneficiaries who meet all of the following categories:

• Aged 55 through 77
• Asymptomatic (no signs or symptoms of lung cancer)
• Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
• Current smoker or one who has quit smoking within the last 15 years
• Receive a written order for lung cancer screening with LDCT

Frequency

Annually for covered Medicare beneficiaries

• First year: Before the first lung cancer LDCT screening, Medicare beneficiaries must receive a counseling and shared decision making visit
• Subsequent years: The Medicare beneficiary must receive a written order furnished during any appropriate visit with a physician or NPP

Medicare Beneficiary Pays

• Copayment/coinsurance waived
• Deductible waived

 Other Notes

• Refer to Medicare Coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) for more information.

Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.

• CMS: Preventive Services Chart | Medicare Learning Network

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