Health Information Management

Q&A: Receive payment for low-dose CT lung cancer screening

APCs Insider, November 6, 2015

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Q: We have been providing lung cancer screening using a low-dose computed tomography (LDCT) scan since coverage was approved in February. However, we still have no way to bill for the services to receive payment. CMS has an NCD and these fall within the coverage guidelines. What do we do with these claims? It can’t be patient responsibility because it is a covered service.
 
A: This is a situation faced by many providers–but there is good news! In the 2016 OPPS final rule, CMS assigned payment for services related to lung cancer screening with LDCT. The HCPCS Level II codes for these services are:
  • G0296, counseling visit to discuss need for lung cancer screening using low LDCT scan (service is for eligibility determination and share decision making)
  • G0297, LDCT for lung cancer screening
Both are assigned to status indicator S (significant procedure not subject to multiple procedure discounting) and assigned to APCs for payment. CMS listened to commenters and has made this retroactive to February 5, 2015. So you may bill the claims for services provided, if they meet the NCD criteria. However, CMS did not extend the timely filing period, so providers must have these billed before the filing period for the claim expires. CMS noted that providers “have sufficient time to file claims prior to the one-year deadline.”
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.

 



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