Even though CMS has approved coverage for CT lung cancer screening, numerous Medicare administrative contractors (MACs) have been denying reimbursement for the test when conducted at IDTFs.
CMS delivered a letter to the ACR in February 2018 explaining that Medicare cannot cover payment for CT lung cancer screening at IDTFs because the test includes a therapeutic activity (i.e., making smoking cessation interventions available for current smokers) that requires billing by a physician.
However, CT lung cancer screening should not be considered an intervention or therapeutic service, according to the ACR and several other groups, including the Radiology Business Management Association (RBMA), the Healthcare Business Management Association (HBMA), the Association for Quality Imaging (AQI), the Medical Imaging and Technology Alliance (MITA), and the Lung Cancer Alliance (LCA).
The groups are now urging CMS to publish a change request transmittal notice instructing all MACs on the following points regarding CT lung cancer screening:
- CT lung cancer screening is not an intervention/therapeutic service.
- The test is a preventive screening service available to Medicare beneficiaries and covered in all settings, including independent diagnostic testing facilities.
- Payment for the test should be retroactive to February 5, 2015.
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