HCPCS G0296: Visit to Determine Low-Dose LDCT Eligibility

Learn how to properly use and bill for HCPCS code G0296 from our short guide.

## **What is HCPCS code G0296?** HCPCS code G0296, as maintained by the Centers for Medicare and Medicaid Services, represents the Counseling visit to discuss the need for lung cancer screening (LDCT) using a low-dose CT scan (service is for eligibility determination and shared decision making). This code is crucial for initiating the Medicare-covered lung cancer screening benefit, as it signifies the mandatory, one-time shared decision-making (SDM) visit required before a beneficiary can receive their first Low-Dose Computed Tomography (LDCT) scan. The service is used for patients aged 50–77 who are current smokers or quit within the last 15 years, and have more than or equal to 20 pack-years history. The counseling visit itself requires detailed documentation, including verifying all eligibility criteria, employing a decision aid to discuss the benefits and harms of the screening (such as potential false positives and radiation exposure), and providing counseling on smoking cessation or maintaining abstinence.

## **Documentation requirements** The patient's medical record must be thoroughly documented to support billing for G0296. The documentation must confirm that the patient meets all eligibility criteria and that the required elements of the counseling and shared decision-making visit were performed. ### **Eligibility determination** The record must clearly document that the patient meets the following criteria (based on current Medicare guidelines): - **Age**: 50–77 years. - **Asymptomatic**: No signs or symptoms of lung cancer. - **Smoking history**: Tobacco smoking history of at least 20 pack-years (1 pack-year = smoking 1 pack per day for 1 year). - **Smoking status**: Either a current smoker or one who has quit smoking within the last 15 years. - **Written order:** Documentation that the patient received a written order for the LDCT lung cancer screening test (if screening is deemed appropriate). ### **Shared decision-making (SDM) visit components** The documentation must specifically address: - Eligibility determination (as noted above, including specific pack-year calculation and years since quitting). - Shared decision-making, including the use of one or more decision aids, discussing the benefits and harms of screening, follow-up diagnostic testing, false positives, overdiagnosis, and radiation exposure. - Lung cancer screening counseling on the importance of adherence to annual screening and the impact of comorbidities as well as smoking cessation if the patient is a current smoker, or on maintaining abstinence if they are a former smoker, including furnishing information about tobacco cessation interventions.

## **Billing requirements** To properly bill for HCPCS code G0296, one must consider the following guidelines: - **Unit of service**: Per visit. - **Who can bill**: Physicians, nurse practitioners, physician assistants, and other qualified non-physician practitioners. - **Setting**: Typically outpatient clinic, physician office, or hospital outpatient department. - **Frequency**: G0296 is billable only once per beneficiary before their first lung cancer LDCT screening. - **Diagnosis codes (ICD-10-CM)**: The claim must be submitted with an appropriate diagnosis code to indicate the smoking status and history. For current smokers, use a code from the F17.21x series. Meanwhile, for former smokers, use Z87.891 or Personal history of tobacco use/personal history of nicotine dependence.

## **Other relevant codes** - **71271**: Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) - **99406/99407 (CPT)**: Smoking and tobacco use cessation counseling (intermediate/intensive) - **G0442**: Annual alcohol misuse screening, 5 to 15 minutes - **G0443**: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

Frequently asked questions

Yes, G0296 is designated as a permanent telehealth code.

Yes, the service must be ordered by a physician or qualified non-physician practitioner, but CMS has removed the restriction on who can provide the counseling and SDM visit, allowing other qualified health professionals to furnish the service.

No. G0296 is only required before the first LDCT screening. Subsequent annual screenings only require a written order, which can be furnished during an appropriate annual visit. The counseling and SDM are optional for subsequent years, but are often a good practice.