2025 HCPCS code G0296
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - G0127-G0372 G0008-G9987 Miscellaneous Diagnostic and Therapeutic Services Feed
Counseling visit to discuss the need for lung cancer screening using low-dose CT scan (LDCT). This service is for eligibility determination and shared decision-making.
Medical necessity for G0296 is established by the patient's age, smoking history, and absence of lung cancer symptoms. The patient must meet specific criteria outlined in the United States Preventive Services Task Force (USPSTF) recommendations and the Centers for Medicare & Medicaid Services (CMS) guidelines.
The healthcare provider is responsible for reviewing the patient's medical history, smoking history, and current health status. They must counsel the patient on the benefits and risks of LDCT lung cancer screening, including the potential for false positives, overdiagnosis, and radiation exposure. The provider also educates the patient about smoking cessation resources and the importance of maintaining abstinence.Finally, the provider determines the patient's eligibility for screening based on established criteria and generates a written order for the LDCT scan if the patient opts to proceed.
In simple words: This is a visit with your doctor to talk about whether lung cancer screening with a low-dose CT scan is right for you.The doctor will check if you meet the requirements for screening and explain the benefits and risks of the test. You'll have a chance to ask questions and decide together if you want to be screened.
This code represents a counseling visit with a healthcare professional to discuss the need for lung cancer screening using low-dose computed tomography (LDCT). The visit focuses on determining patient eligibility based on established criteria (age, smoking history, absence of symptoms) and engaging in shared decision-making. This involves discussing the benefits and harms of screening, including the possibility of false positives, overdiagnosis, and radiation exposure.Counseling on maintaining smoking abstinence (for former smokers) and smoking cessation resources (for current smokers) are integral components of this visit.A written order for the LDCT scan is generated if the patient is deemed eligible and chooses to proceed with screening.
Example 1: A 60-year-old patient with a 35-pack-year smoking history who quit 5 years ago presents for a lung cancer screening discussion. The provider reviews the eligibility criteria, discusses the benefits and risks of LDCT screening, and answers the patient's questions.A written order for the scan (CPT code 71271) is provided., A 50-year-old current smoker with a 25-pack-year history presents for lung cancer screening counseling. The provider discusses the screening process, emphasizing the importance of smoking cessation.The patient is provided with resources for smoking cessation programs., A 70-year-old patient with a history of lung cancer 10 years ago presents for lung cancer screening counseling.The provider explains that the patient is not eligible for screening based on their prior history of lung cancer. Alternative surveillance strategies are discussed.
Documentation should include the patient's age, smoking history (pack-years), date of smoking cessation (if applicable), current symptoms, discussion of benefits and risks of LDCT screening, shared decision-making process, patient's decision regarding screening, and a written order for 71271 (if applicable).
** As of December 1, 2024, this information is current.Refer to the iFrameAI product for the most up-to-date coding information. CPT code 71271 is used for the low-dose CT scan itself.ICD-10-CM codes for current smokers (F17.210-F17.219) or a personal history of nicotine dependence (Z87.891) should be reported.
- Payment Status: Active
- Specialties:Pulmonology, Family Medicine, Internal Medicine, Oncology
- Place of Service:Office, Outpatient Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home