ACR Recommends Valuation for Lung Cancer Screening Code

August 25, 2014

The American College of Radiology (ACR) recently recommended a valuation for the new S-code that, starting October 1, 2014, providers will use for billing low-dose CT (LDCT) for lung cancer screening. ACR said the reimbursement should be at least equal to that for CT of the thorax, without contrast material (CPT 71250).

The S-code for low-dose CT lung cancer screening (S8032 Low-dose computed tomography for lung cancer screening) was included in the quarterly update of Healthcare Common Procedure Coding System (HCPCS) codes released by the Centers for Medicare and Medicaid Services in July and which will go into effect October 1. But neither Medicare nor Medicaid pays for S-Codes.

Thus, private payers—which use the codes for reporting of drugs, services, and supplies when no national codes for a specific procedure are available-- are responsible for assigning values to the codes. In doing so, they often look to specialty societies for assistance in valuation.

The ACR believes that the reimbursement floor for low-dose CT for lung cancer screening should be set at the value of CPT 71250 (Computed tomography, thorax; without contrast material). Additional activities that are necessary for an effective lung cancer screening program should be paid extra, according to ACR.