IDTFs Can and Should Bill for Low-Dose CT for Lung Cancer Screening

Independent diagnostic testing facility (IDTF) locations can and should be reimbursed by Medicare for lung cancer screening (LCS) with low-dose computed tomography (LDCT) scan (CPT code 71271) if coverage criteria are met. Additionally, lung cancer screening is covered in an IDTF setting for patients with commercial insurance or Medicaid. LDCT LCS is a covered benefit in all facilities, including IDTFs, where the LDCT exam is performed and interpreted.

In its final national coverage determination 210.14 Screening for Lung Cancer with LDCT, the Centers for Medicare and Medicaid Services (CMS) removed the requirement for smoking cessation interventions for current smokers from the radiology imaging facility criteria. The removal of this requirement expands access to lung cancer screening by increasing accessibility in an IDTF setting. The American College of Radiology® (ACR®) applauds CMS for streamlining the process to allow IDTFs the ability to perform and receive reimbursement for lung cancer screening.

The ACR recommends IDTFs that experience Medicare claim denials or billing challenges contact their Medicare Administrative Contractor (MAC) and/or download the IDTF billing and coding article for their MAC region.

A Solution to Billing Concerns

IDTFs may address billing issues by updating their Medicare enrollment application to include 71271, Computed tomography, thorax, low-dose for lung cancer screening, without contrast material(s), and get reimbursed for performing the LDCT scan. The Medicare Learning Network® (MLN) booklet explains the requirements for an IDTF to enroll in the Medicare Program.

The ACR Economics & Billing guidance document details economic policy and billing information for lung cancer screening. These policy changes eliminate barriers to screening and increase awareness of the benefits of lung cancer care.

For questions, contact Alicia Blakey, ACR Principal Economic Policy Analyst, or email LCScoverage@acr.org.