The Centers for Medicare & Medicaid Services (CMS) issued a national coverage determination (NCD) for Medicare coverage of screening for lung cancer with low dose computed tomography (LDCT) if certain eligibility requirements are met, effective February 5, 2015. Detailed information regarding the eligibility requirements is available in the NCD on the CMS.gov website (Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N). While the coverage for the care to Medicare patients is available as of the effective date, the billing instructions have not yet been communicated to the Medicare Administrative Contractors (MAC). CMS on an open door call April 7, 2015, stated, “providers need to make their own decisions if they will offer these services and when.” Providers have the option to hold claims or submit, however if the MACs do not have the billing instructions claims are likely to be denied. The ATS is concerned that Medicare has left many unanswered questions. Some questions that remain unanswered at this time are:
- When does CMS expect to issue billing instructions to the contractors?
- What code can be used to report the shared decision making visit?
- Will all Medicare patients be spared the cost-sharing expense for the visit or for the procedure?
Providers can submit their own questions directly to CMS at Hospital_ODF@cms.hhs.gov. The ATS will hold a Webinar for our members once the CMS billing instructions are released and we have additional information from CMS.
