Before a Medicare patient can undergo a Low Dose Computed Tomography (LDCT) lung cancer screening, they must have a Shared Decision Making (SDM) visit. This visit is billed using G0296.
Eligibility for G0296
Medicare covers this visit if the patient meets all of these criteria:
- Age 50 to 77 years.
- Asymptomatic (no signs or symptoms of lung cancer).
- Tobacco smoking history of at least 20 pack-years.
- Current smoker or one who has quit within the last 15 years.
Medical Necessity Documentation
You must document the use of a decision aid, counseling on the benefits and harms of LDCT, counseling on adherence to annual screening, and counseling on smoking cessation. Use ICD-10 code Z87.891 (Personal history of nicotine dependence) or F17.210 (Nicotine dependence, cigarettes, uncomplicated).
NCCI Edits
G0296 is typically billed on its own, but if performed during an AWV or standard E/M, proper modifier usage (Modifier 25) is required.