{"id":7834,"date":"2022-06-27T20:18:51","date_gmt":"2022-06-27T14:48:51","guid":{"rendered":"https:\/\/www.medisysdata.com\/blog\/?p=7834"},"modified":"2022-10-11T19:09:43","modified_gmt":"2022-10-11T13:39:43","slug":"revised-medicare-guidelines-for-lung-cancer-screening-using-ldct","status":"publish","type":"post","link":"https:\/\/www.medisysdata.com\/blog\/revised-medicare-guidelines-for-lung-cancer-screening-using-ldct\/","title":{"rendered":"Revised Medicare Guidelines for Lung Cancer Screening Using LDCT"},"content":{"rendered":"<h2>CMS Announcement for Revised Coverage<\/h2>\n<p>The Centers for Medicare and Medicaid Services (CMS) has announced a shift in its eligibility criteria for coverage of lung cancer screening using low-dose CT (LDCT), with implementation date of October 3<sup>rd<\/sup>, 2022. In addition, CMS also made other modifications to its eligibility criteria that will increase the ability of more people to obtain access to screening, effective February 10, 2022. The changes in <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_coverage_determination\" target=\"_blank\" rel=\"noopener\">National Coverage Determination<\/a> (NCD) are as follows:<\/p>\n<ul>\n<li>CMS expanded patient eligibility for screening for lung cancer with low dose computed tomography (LDCT), including lowering the minimum age for screening<\/li>\n<li>CMS also removed the restriction that a physician or non-physician practitioner must provide the counseling and shared decision-making (SDM)<\/li>\n<li>CMS removed the requirement that facilities participate in a registry<\/li>\n<\/ul>\n<h2>Basics of Low Dose Computed Tomography (LDCT)<\/h2>\n<p>The only recommended screening test for lung cancer is LDCT. It\u2019s a unique CT scan technique that combines special x-ray equipment with sophisticated computers to produce multiple, cross-sectional images or pictures of the inside of the body. CMS made the policy changes, effective February 10, 2022:<\/p>\n<ul>\n<li>Expanded patient eligibility for screening for lung cancer with LDCT to closely align with the U.S. Preventive Services Task Force recommendation<\/li>\n<li>Lowered the minimum age for screening from 55 to 50 years and reduced the smoking history from at least 30 pack-years to at least 20 pack-years<\/li>\n<li>Simplified the requirements for the counseling and SDM visit<\/li>\n<li>Removed the restriction that a physician or non-physician practitioner must provide the counseling and SDM<\/li>\n<li>Reduced the eligibility criteria for the reading radiologist<\/li>\n<li>Reduced the radiology imaging facility eligibility criteria (including removing the requirement that facilities participate in a registry).<\/li>\n<\/ul>\n<h3>With these changes, Medicare:<\/h3>\n<ul>\n<li>Will allow you to bill codes G0296 and 71271 for patients between the ages of 50 and 77 for claims with a date of service on or after February 10, 2022<\/li>\n<li>Won\u2019t search for and adjust LDCT claims with dates of service February 10, 2022 &#8211; October 3, 2022, but they\u2019ll adjust such claims that you bring to their attention.<\/li>\n<\/ul>\n<h2>Beneficiary Eligibility Criteria<\/h2>\n<p>For purposes of Medicare coverage of lung cancer screening with LDCT, beneficiaries must meet all of the following eligibility criteria:<\/p>\n<ul>\n<li>Age 55 \u2013 77 years;<\/li>\n<li>Asymptomatic (no signs or symptoms of lung cancer);<\/li>\n<li>Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);<\/li>\n<li>Current smoker or one who has quit smoking within the last 15 years; and<\/li>\n<li>Receive a written order for lung cancer screening with LDCT. Written orders for lung cancer LDCT screenings must be appropriately documented in the beneficiary\u2019s medical records, and must contain the following information:\n<ul>\n<li>Beneficiary date of birth;<\/li>\n<li>Actual pack \u2013 year smoking history (number);<\/li>\n<li>Current smoking status, and for former smokers, the number of years since quitting smoking;<\/li>\n<li>Statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer); and<\/li>\n<li>National Provider Identifier (NPI) of the ordering practitioner.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2>Reading Radiologist Eligibility Criteria<\/h2>\n<ul>\n<li>For purposes of Medicare coverage of lung cancer screening with LDCT, the reading radiologist must meet all of the following eligibility criteria:<\/li>\n<li>Board certification or board eligibility with the American Board of Radiology or equivalent organization;<\/li>\n<li>Documented training in diagnostic radiology and radiation safety;<\/li>\n<li>Involvement in the supervision and interpretation of at least 300 chest computed tomography acquisitions in the past 3 years;<\/li>\n<li>Documented participation in continuing medical education in accordance with current American College of Radiology standards; and<\/li>\n<li>Furnish lung cancer screening with LDCT in a radiology imaging facility that meets the radiology imaging facility eligibility criteria.<\/li>\n<\/ul>\n<h2>Radiology Imaging Facility Eligibility Criteria<\/h2>\n<p>For purposes of Medicare coverage, lung cancer screening with LDCT must be furnished in a radiology imaging facility that meets all of the following <a href=\"https:\/\/www.medisysdata.com\/services\/consulting-services\" target=\"_blank\" rel=\"noopener\">eligibility criteria<\/a>:<\/p>\n<ul>\n<li>Performs LDCT with volumetric CT dose index (CTDIvol) of \u2264 3.0 mGy (milligray) for standard size patients (defined to be 5&#8242; 7&#8243; and approximately 155 pounds) with appropriate reductions in CTDIvol for smaller patients and appropriate increases in CTDIvol for larger patients;<\/li>\n<li>Utilizes a standardized lung nodule identification, classification and reporting system;<\/li>\n<li>Makes available smoking cessation interventions for current smokers; and<\/li>\n<li>Collects and submits data to a CMS-approved registry for each LDCT lung cancer screening performed.<\/li>\n<\/ul>\n<p>Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding for your practice. If you need any assistance in billing for Medicare, contact us at info@medisysdata.com\/ 302-261-9187<\/p>\n<p>References:<\/p>\n<p><a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncd.aspx?NCDId=364&amp;ncdver=1&amp;bc=AAAAQAAAAAAA&amp;\">National Coverage Determination (NCD): Lung Cancer Screening with Low Dose Computed Tomography (LDCT)<\/a><\/p>\n<p><a href=\"https:\/\/www.cms.gov\/files\/document\/mm12691-national-coverage-determination-ncd-21014-reconsideration-screening-lung-cancer-low-dose.pdf\">MLN Document: Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>CMS Announcement for Revised Coverage The Centers for Medicare and Medicaid Services (CMS) has announced a shift in its eligibility criteria for coverage of lung cancer screening using low-dose CT (LDCT), with implementation date of October 3rd, 2022. In addition, CMS also made other modifications to its eligibility criteria that will increase the ability of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":7835,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","footnotes":""},"categories":[3],"tags":[271],"class_list":["post-7834","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-lungcancerscreening-radiology-radiologist-medicalbilling-medicalcoding-healthcare-medicare-medicaid-physician-patient"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.4 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Revised Medicare Guidelines for Lung Cancer Screening Using LDCT<\/title>\n<meta name=\"description\" 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