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Updated Coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)

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Bulletin
Effective Date:

To:
All Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
From:
Cheryl J. Roberts, Acting Director Department of Medical Assistance Services (DMAS)

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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PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

https://vamedicaid.dmas.virginia.gov/

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

KEPRO

Service authorization information for fee-for-service members.

 

https://dmas.kepro.com/

 

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

https://www.dmas.virginia.gov/for-providers/long-term-care/

Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

www.MagellanHealth.com/Provider

For credentialing and behavioral health service information, visit:

www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or

Call: 1-800-424-4046

Provider HELPLINE

Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.

1-804-786-6273

1-800-552-8627

Aetna Better Health of Virginia

www.aetnabetterhealth.com/Virginia

 1-800-279-1878

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-800-901-0020

Magellan Complete Care of Virginia

www.MCCofVA.com

 1-800-424-4518 (TTY 711) or 1-800-643-2273

Optima Family Care

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare

www.uhccommunityplan.com/VA

and www.myuhc.com/communityplan

1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711), www.virginiapremier.com