Wiki BCBS-NC referrals for CT lung screenings

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laceyb1116

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What does BCBS require in order to approve a CT lung screening order? We have had some primary doctors tell our radiologists that they were unable to get approval for these screenings through BCBS. Is there a specific code that needs to be reported?

Any help is appreciated!
 
I don't know about NC but here is the criteria i've seen in Mississippi and Tennessee policy . I assume based on your other post that its for lung cancer screening?

https://www.bcbsms.com/index.php?q=.../policy/emed/Helical_Computed_Tomography.html

POLICY

Low-dose computed tomography (CT) scanning, no more frequently than annually, may be considered medically necessary as a screening technique for lung cancer in individuals who meet ALL of the following criteria*:

-Between 55 and 80 years of age
-History of cigarette smoking of at least 30 pack-years
-If former smoker, quit within the previous 15 years

* Patient selection criteria are based on the National Lung Screening Trial (NLST) and the U.S. Preventive Services Task Force (USPSTF) 2013 recommendation. Refer to the Preventive Health Services medical policy.

Low-dose CT scanning is considered investigational as a screening technique for lung cancer in all other situations.
 
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