Community First Health Plans is providing guidance on coverage and billing requirements for lung cancer screening with low‑dose computed tomography (LDCT). Proper coding and claims submission
support accurate claims processing and compliance with Centers for Medicare & Medicaid Services (CMS) coverage guidelines.
Effective June 1, 2026, Community First will follow CMS coverage requirements for LDCT lung cancer screening services. Claims not meeting the following requirements will be denied.
Covered Indications
Screening for lung cancer with low‑dose computed tomography (LDCT), including CPT® 71271 and the associated counseling visit HCPCS G0296, is covered only when billed with an appropriate diagnosis and when all coverage criteria are met. Covered diagnoses include personal history of nicotine dependence (Z87.891) or nicotine dependence, cigarettes (F17.21–F17.219).
Frequency Limitations
Computed tomography, low dose for lung cancer screening (71271) may be billed no more than once within a 12‑month period, defined as 11 full months having elapsed since the previous screening.
Age Limitations
Services related to screening lung cancer with LDCT (71271, G0296) are covered routinely only for patients between 50 and 77 years of age.
Key Takeaway
Lung cancer screening with LDCT is subject to specific diagnosis, age, and frequency requirements. Claims that do not meet CMS aligned coverage guidelines will be denied.
Action:
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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