Medical billing and procedural coding procedures in complex environments benefit from CPT codes to improve patient care operations as well as reimbursement processes. CPT code G0297 emerges as an essential procedural code that regulates preventive healthcare services. The G0297 CPT code describes a diagnostic medical imaging test called low-dose CT (LDCT) that screens populations at risk of developing deadly lung cancer. Lung cancer continues to be one of the leading cancer-related causes of mortality yet proper early detection proves life-saving.
Medicare administrators used G0297 as their exclusive CPT code for processing low-dose CT (LDCT) lung cancer screening applications for several years. Healthcare providers along with billers and patients who work with lung cancer screening need complete G0297 knowledge because the coding and billing procedures have undergone recent changes. This extensive guide presents the key aspects of CPT G0297 including procedural importance and approval standards and documentation methods and current updates and reimbursement amounts.
What is G0297 CPT Code?
Healthcare providers use CPT code G0297 to document low-dose computed tomography (LDCT) scans of the thorax as a lung cancer screening test for asymptomatic patients who fulfill defined eligibility standards. Lung cancer screening presents a simple method to examine high-risk patient populations through quick non-invasive procedures which allows early detection of cancer.
The low-dose computed tomography (LDCT) scan provides pulmonary imaging to detect early-stage lung cancer. Through Medicare’s preventive service expansion the code entered into effect through a program that supports LDCT screening for lung cancer based on USPSTF Grade B recommendations.
Why is G0297 So Important?
Lung cancer stands among the top cancer-related death causes throughout the United States. Existing diagnosis of lung cancer commonly occurs when treatment possibilities remain minimal with poor anticipated outcomes. LDCT screening achieves up to a 20% decrease in lung cancer survival rates according to clinical trials that establish this detection method’s success.
Screening services identified by CPT G0297 allow providers to provide this essential testing free of charge to suitable patients based on successful fulfillment of Medicare requirements and private insurance coverage.
Eligibility Criteria for G0297
An established process to bill G0297 accurately requires patients to fulfill requirements set by the CMS (Centers for Medicare & Medicaid Services).
- Age: The screening is available to patients who fall between 50–77 years old per updated CMS criteria that shifted the eligibility range from 55–77.
- Smoking History: A patient demonstrates eligibility for this service through their combination of thirty-year smoking experience and ongoing tobacco use or past-year use. The patient either continues smoking behavior or quit smoking during the previous 15 years.
- Asymptomatic: Lung cancer screening using G0297 requires patients who show no symptomatology of lung cancer.
- Shared Decision-Making Visit (SDM): A documented counseling session using payment code G0296 must occur before the first screening appointment takes place.
- Facility Requirements: Patients need to receive screenings at accredited medical sites using CT scanners that have received FDA approval.
Required Documentation
Reimbursement depended heavily on accurate documentation of all procedures.
- Patient’s date of birth
- Actual pack-year smoking history
- A patient's details include actual pack-years of smoking in combination with present smoking habits and duration since ex-smoking for those who previously smoked.
- Statement of no symptoms
- A doctor's National Provider Identifier (NPI) serves as part of required documentation.
Billing Guidelines & Reimbursement for G0297
The HCPCS code G0297 served as the billing identifier for low-dose CT (LDCT) lung cancer screening until it received its deletion status from Medicare as part of the 2021 coding changes. All G0297 claims filed after January 31, 2021 will receive denial notices. The new requirement for screening LDCT lung cancer uses CPT code 71271. Reimbursement from Medicare depends on accurate ICD-10 diagnosis codes that show patient smoking history with Z87.891 for ex-smokers and F17.21/F17.210 for ongoing smokers.
G0296 remains the correct billing code for the initial counseling followed by shared decision-making process. The program only reimburses one yearly screening examination but strict documentation requirements exist for payment to occur.
Average Reimbursement Rates (2025):
Payer | Estimated Reimbursement |
Medicare | $240–$280 |
Private Payers | $250–$400 depending on contract |
Medicaid (varies by state) | $100–$250 |
Place of Service (POS) Codes:
POS Code | Description |
22 | Outpatient Hospital |
11 | Office (must have in-house CT scanner) |
24 | Ambulatory Surgical Center |
Step-by-Step Billing Workflow for G0297
1. Screen patient eligibility (Age, smoking history, quit date)
The patient qualifies for screening if they meet the age criteria of 50 to 77 years and count a minimum of 30 packs for their smoking history and are currently smoking or stopped within 15 years.
2. Schedule SDM visit (Bill as G0296)
Plan a visit about LDCT screening risks and benefits alongside documentation of patient informed consent through shared decision-making.
3. Document SDM and order LDCT scan
During the SDM discussion the provider should both document the conversation and initiate referral and ordering steps for low-dose CT lung cancer screening.
4. Refer to accredited imaging center
Choose a CMS-approved facility for the scan that maintains standards for lung cancer screening accreditation.
5. Perform LDCT scan (Bill as G0297)
Patients should undergo Low-Dose CT Screening after which providers should submit the G0297 HCPCS code claim with necessary documentation.
6. Submit documentation and claim
The clean claim submission should contain all mandatory components including patient characteristics (age, smoking status) and SDM session details and facility accreditations.
7. Track annual reminder for next screening
Through alerts in electronic medical records and patient recall systems healthcare providers must arrange annual screenings for patients who qualify by eligibility criteria.
Why Was G0297 Replaced?
Lung cancer screening billing now uses 71271 which conforms with CPT standards to facilitate easier processing for providers and payers. This change incorporates both new screening standards and improved coding methods.
G0297 Billing Errors You Need to Fix and Their Solutions
Using G0297 After Retirement: Any medical claims filed with G0297 after January 31, 2021 will receive automatic denial and 999 error receipts. All LDCT lung cancer screening exams must use CPT 71271 beginning on February 1, 2021 onward.
- Incorrect Diagnosis Codes: Medical claims not containing the proper ICD-10 codes Z87.891 for former smokers or F17.21 or F17.210 for present smokers receive rejection. Medical billing staff needs to select the diagnosis code which accurately describes each patient's tobacco usage condition.
- Omitting Required Documentation: Absence of necessary documentation about patient selection or shared decision-making consultations (G0296) will lead to denied insurance claims. All eligibility requirements along with counseling sessions must be recorded correctly to qualify for billing.
- Billing Outdated Codes: Errors occur when providers use CPT codes 71250-71270 or G0297 instead of billing 71271 for screening. Healthcare providers should exclusively file claims for LDCT lung cancer screening with code 71271 when performing the tests.
- Frequency Errors: Patients who receive multiple annual screenings risk receiving denial for payment. Obtain and maintain proper control of each patient's yearly screening limit.
Conclusion
G0297 functions as a vital code which serves as an entry point for early detection of lung cancer while bringing the potential to preserve lives. Providers can deliver a critically essential preventive service while maintaining full Medicare and commercial payer coverage after meeting requirements for shared decision-making visits and documentation and coding protocols.
G0297 provides medical practices a chance to deliver high-value patient care and better clinical results while improving revenue streams by effective billing methods. Make G0297 an important part of your annual preventive care procedure by ensuring compliance and preventing reimbursement denials.
FAQ - People Also Asks
CPT G0297 the same as a regular chest CT?
No. G0297 is low-dose, specifically for lung cancer screening, and billed under preventive services.
Do I need prior authorization for G0297?
Some private payers may require it. Medicare typically does not require prior auto if eligibility is met.
What if the patient shows symptoms during LDCT screening?
If lung symptoms are documented, switch to a diagnostic CT (CPT 71250), not G0297.
Can G0297 still be used for any insurance?
No, G0297 is retired for Medicare and most payers. Always verify with commercial insurers, but CPT 71271 is now the standard.