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KMAP BULLETIN: Coverage for Low Dose Lung CT

Date: 06/12/20

KMAP GENERAL BULLETIN 20125 (PDF)

Effective with dates of service July 1, 2020, a counseling visit to discuss the need for a lung cancer screen using low dose CT (LDCT) scan (G0296) and LDCT scan for lung cancer screening (G0297) will be covered by Kansas Medicaid with Prior Authorization (PA) for the Fee-for-Service (FFS) population.

Individuals must meet all criteria requirements, to have these services covered every 12 months.

The written orders for lung cancer LDCT screenings must be documented in the beneficiary’s medical record before the first lung cancer LDCT screening occurs. The beneficiary must receive a written order for LDCT lung cancer screening during a Lung Cancer Screening Counseling and Shared Decision-Making visit that includes the following elements and is documented in the beneficiary’s medical records. The service must be furnished by a physician (as defined in section 1861[aa][5] of the Act) or qualified non-physician practitioner, meaning a Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS) (as defined in section1861[aa][5] of the Act), must include all of the following elements:

  • Determination of beneficiary eligibility
    • Age (55-77)
    • Asymptomatic (absence of signs or symptoms of lung cancer)
    • A specific calculation of cigarette smoking pack-years (tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
    • If a former smoker, the number of years since quitting
  • Shared decision-making, including the use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure.

Note: The effective date of the policy is July 1, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.