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The purpose of this memorandum is to affirm that DMAS Fee For Service (FFS) and all managed care organizations (MCOs) will cover screening for lung cancer with low dose computed tomography (LDCT), and associated counseling, consistent with recently revised United States Preventive Services Task Force (USPSTF) recommendations. Coverage applies to all FFS and MCO FAMIS and full-benefit Medicaid members. 

The following billing codes will be covered for FFS and MCO FAMIS and full-benefit Medicaid member claims with dates of service on and after March 9, 2021 and when billing requirements are met as outlined below. See the DMAS fee file (MMIS) from within the MES webpage for FFS rates:

• 71271: Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
• G0296: Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)

Providers must ensure Medicaid beneficiaries meet all of the following billing requirements, and maintain corresponding documentation, when billing the codes listed above:

• 50–80 years of age; and
• Tobacco smoking history of at least 20 pack years; and
• Current smoker, or former smoker who has quit smoking within the last 15 years

Service authorization is not required for either of the billing codes listed above for any FFS or MCO members. While claims should only be submitted for members meeting the criteria above, claims will not be denied based on diagnosis codes accompanying claims. For patients still actively smoking, we recommend referring patients for the smoking cessation treatment and counseling services covered for the same population.

For questions on coverage for members enrolled in a managed care organization, refer to the contact information listed below.

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