CPT Code 71271: Low-Dose CT for Lung Cancer Screening

What is low-dose CT for lung cancer screening (CPT 71271)?

Computed tomography, or CT, is a type of imaging that uses X-rays to create detailed pictures of the inside of the body. It’s important because it helps doctors see things they can’t catch with regular X-rays, like small tumors or lung nodules.

So, when are they used? CT scans are often used when someone has symptoms or risk factors that might point to serious conditions, such as cancer. One type of CT scan is called low-dose computed tomography (LDCT), which uses less radiation than a standard CT scan but still gives clear images.

The code CPT 71271 refers to "computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)". This scan specifically looks at the chest area to check for early signs of lung cancer.

It’s usually recommended for people who are at higher risk, like long-time smokers or those with a family history of lung cancer. The term “low dose” means the scan uses reduced radiation, which is safer for regular screenings. No contrast dye is used, so it’s a simple, non-invasive procedure. Basically, low-dose CT for lung cancer screening is valuable in helping catch lung cancer early, when it’s most treatable.

CPT code 71271 documentation requirements

Proper documentation is essential to ensure the scan is medically necessary and meets the criteria set by insurance providers and screening guidelines.

Here are the key documentation requirements for CPT code 71271:

• Screening eligibility documentation (evidence that the patient meets Medicare or guideline-based criteria, typically adults aged 50–77 with a 20 pack-year smoking history who currently smoke or quit within the last 15 years)
• A documented order from a qualified healthcare provider was made after a shared decision-making conversation about the screening.
• Shared decision-making documentation confirming that the patient was informed about the purpose of the screening, possible outcomes, next steps if abnormalities are found, and the risks, such as radiation exposure
• Asymptomatic status confirmation that the patient has no signs or symptoms suggestive of lung disease (meaning the scan is preventive, not diagnostic)
• Annual screening plan stating that the scan is part of a recurring, annual screening program in line with clinical recommendations
• Smoking cessation support documentation specifying that resources or counseling (if applicable) were offered to patients who currently smoke, supporting cessation efforts as part of overall care.
• Low-dose, non-contrast scan notation confirming that a low-dose CT scan without contrast was performed specifically for lung cancer screening purposes
• Radiology report detailing the scan findings, including any lung nodules—their size, shape, and location.
• Screening interpretation and follow-up plan with recommendations for follow-up actions or timelines based on screening guidelines.

When all the right details are documented, it makes it easier for insurance to cover the LDCT scan and shows that the care follows the right guidelines. Good records also help protect providers if there’s ever a review or audit.

CPT code 71271 billing guidelines

Providers must follow certain rules when billing for this service so Medicare and insurance companies will cover it.

Here are the billing guidelines for LDCT lung cancer screening:

• Use with another code (G0296): Lung cancer screening includes a visit where the patient talks with a doctor about whether they qualify. That visit is billed using code G0296. The actual scan is billed separately using CPT 71271.
• Radiologist qualifications: The interpreting radiologist must be board-certified or board-eligible in radiology. This ensures that they are trained to spot early signs of lung cancer.
• Facility requirements: The scan must be done in a place with a clear system for spotting and describing lung nodules. This helps keep the reporting consistent and reliable.
• Special rules for imaging centers: Independent Diagnostic Testing Facilities (IDTFs) can perform the LDCT scan. However, since the screening includes therapeutic components like smoking cessation counseling, a physician must bill the scan. The IDTF must have a business arrangement with the physician for cooperative service delivery, and payment should come from the physician, not directly to the IDTF.
• Anti-markup rule: If a doctor bills for a scan done somewhere else, they must follow anti-markup rules to prevent overcharging.

Medicare will cover the scan if all the steps are followed, like getting a doctor’s order and ensuring the patient qualifies.