When CMS issued its immediately effective coverage decision on screening LDCT for high-risk lung cancer patients on February 5, 2015, it left some important questions unanswered for providers, including how much it will pay for the procedure.
Going on the proactive, the ACR posted answers to common questions on its Web site regarding:
- patient eligibility,
- center eligibility,
- radiologist requirements,
- billing and payment,
- the status of the ACR Clinical Practice Registry for LDCT lung cancer screening, and
- accreditation and the college’s lung cancer screening designation.
According to the document posted on the ACR Web site, CMS is likely to require months not days to determine a payment rate and circulate coding and payment instructions to its carriers.
In a meeting pending with CMS, the ACR will recommend that the coding structure mirror the private payor S-code (S8032) issued by CMS in July, effective October 2014. At that time, ACR recommended that the payment rate of CPT® code 71250 (CT, thorax; without contrast) serve as the payment floor, with additional payment for the numerous value added-services required of an effective screening program.
In the meantime, with both Medicare and Medicaid covering the procedure for qualified patients, providers are left to sort this out on a market-by-market basis. The California Radiological Society (CRS) suggested to members in an advisory that they hold claims until a rate has been established by Medicare and local carrier Noridian.
Claims for Medi-Cal patients are be processed manually on a By Report basis, according to the CRS advisory reports. CRS is waiting to hear what the Medi-Cal reimbursement rate will be.
According to the document, to be eligible to provide the service, a center must:
- be able to produce an LDCT study with a CTDIvol of less than or equal to 3.0 mGy for standard size patients (5’7” and approximately 155 pounds, withreductions for smaller patients and increases for larger ones;
- utilize a standardized lung nodule identification, classification and reporting system;
- make smoking cessation interventions available for smokers; and
- collect and submit specific data elements to a CMSD-approved national registry for each LDCT lung cancer screening provided.
To be eligible to interpret the studies, radiologists must:
- be board certified or board eligible with the American Board of Radiology or equivalent organization;
- have been involved with the supervision and interpretation of at least 300 chest CTs in the past three years;
- have documented CME as per the ACR guidelines and parameters; and
- furnish LDCT lung cancer screening in a medical imaging facility that meets the criteria specified by CMS.
To read the answers to additional questions, visit the post on the ACR Web site.