Can specialists provide LDCT counseling?

SUEV

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Local Chapter Officer
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Can anyone point me to CMS regulations (other than the MLN article) regarding who can bill for G0296? In a webinar from AAPC dated 04/20/16, the presenter said pulmonologists could not bill for this-only the PCP. The MLN from 2015 seems to support this. At least 2 specialty societies have a different take. From the American College of Radiology: CMS clarified to several professional organizations on Feb. 1, 2016 that “the National Coverage Determination (NCD) for Lung Cancer Screening with LDCT (210.14) is based on the recommendation of the U.S. Preventive Services Task Force (USPSTF), whose general focus is the primary care provider and setting. We recognize the NCD does not specifically state primary care physician or setting. Based on the NCD and applicable regulations, the physician or non-physician practitioner who furnishes the shared-decision making visit and orders the LDCT must be treating the beneficiary and use the results in the management of the beneficiary's specific medical problem to ensure improved health outcomes.”
The American Thoracic Society has this on their website: "In its clarification statement, CMS states, “Based on the NCD and applicable regulations, the physician or non-physician practitioner who furnishes the shared-decision making visit and orders the LDCT must be treating the beneficiary and use the results in the management of the beneficiary’s specific medical problem to ensure improved health outcomes.” This clarification of its earlier statement is final assurance that pulmonary providers and other specialists can order lung cancer screening and provide the shared-decision making visit, provided all other CMS requirements are met". Since these pulmonologists are probably treating their patients for COPD and other respiratory issues, they are recommending specialists bill for these services. I have been unable to find anything from CMS that corroborates what the societies say they were told by CMS but don't want to discount it either if it's true. Is anyone billing for specialists providing the counseling or will CMS deny these services?
Thanks,
Sue
 
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G0296

Hi Sue, I was just wondering if you have started billing this. I've came across the same information as you and am wondering if we can bill it too.

Thanks, Amanda
 
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