CPT Codes

The Ultimate Guide to G0296 CPT Code: Lung Cancer Screening Counseling (2025)

G0296 CPT Code

Lung cancer continues to be one of the leading causes of death from cancer across the world. Detection is early, and LDCT has set the game changer in recognizing lung cancer in its earliest, most treatable stages. However, before receiving LDCT screening, a counseling and shared decision making visit, which is billed under the g0296 CPT Code/HCPCS, is reimbursable for Medicare and most insurers.

We’ll discuss all that you need to know about the code, eligibility, documentation, reimbursement, best practices, and frequently asked questions.

What is G0296 CPT Code? Understanding the Code

G0296 is a code from the HCPCS set for:

“Counseling visit to discuss the need for lung cancer screening using low dose CT scan (LDCT) (service is for counseling and shared decision making before the first screening LDCT is performed).”

This code is crucial to providers who want to be compliant with the requirements of Medicare and other payers regarding lung cancer screening.

Why is G0296 Important?

Who Can Bill G0296?

Eligibility Criteria for G0296

As per the 2022 CMS updates, beneficiaries must meet the following criteria:

Documentation Requirements

Compliance and reimbursement of reimbursement require accurate documentation.

Reimbursement and Coverage for CPT Code G0296

CPT code G0296 is central to Medicare’s preventive services for early detection of lung cancer through counseling and shared decision making (SDM). Compliance and accurate billing are facilitated by knowledge of the reimbursement and coverage nuances.

Reimbursement Rates

Payment for G0296 is contingent on location.

Billing Considerations

  1. Frequency: G0296 is billable once per beneficiary before the first LDCT screening.
  2. Modifiers: If performed on the same day as an Evaluation and Management (E/M) service, append modifier -25 to the E/M code.
  3. Place of Service (POS):
    1. 11: Office.
    2. 22: Outpatient hospital.
    3. 10: Telehealth provided in the patient’s home.
  4. Telehealth: G0296 is approved for telehealth, including audio-only visits.

Institutional Billing

For institutional claims, G0296 is payable under the following Type of Bill (TOB) codes:

Compliance and Best Practices for G0296 Billing

How to Bill G0296: Step-by-Step

G0296 vs. Related Codes

Code

Description

When Used

G0296

Counseling visit for LDCT lung cancer screening

Before the first LDCT screen

71271

Low-dose CT scan for lung cancer screening (replaces G0297)

For the actual scan

G0297

Low-dose CT scan for lung cancer screening (deleted after 2020)

No longer in use

Annual Screening and Follow-Up

After concluding the G0296 procedures of patient consultation and ordering a written prescription, one can move on to the procedure of LDCT scan coded by CPT code G0297. This Order of counseling followed by screening should be reiterated yearly while the patient is eligible and asymptomatic.

Annual eligibility needs to be monitored, and reminders are important, especially in long-term screening programs.

2025 CMS Updates for G0296

In 2025, G0296 is a CPT Medicare HCPCS code for mandatory counseling and shared decision-making before the first LDCT lung cancer screening visit. It’s for the adults aged 50–77 with at least a 20 pack-year smoking history who still smoke or quit within 15 years and have no lung cancer symptoms. The visit should include eligibility determination, screening for benefits/risks (using decision aids), and smoking cessation counselling. Documentation should include everything of these points and the LDCT written order. G0296 is free to Medicare patients and may be undertaken through telehealth. Codes for cessation of smoking cannot be billed on the same day (99406/99407). For current smokers, use the diagnosis codes F17.21x; for former smokers, use Z87.891. Reimbursement is guaranteed when proper documentation is provided and CMS guidelines are followed.

Conclusion

G0296 billing is not just a compliance check- it’s a critical point of lung cancer screening that is patient-centered and of high quality. By adhering to the up-to-date CMS guidelines, implementing best practices into your workflow, and implementing thorough documentation, you are guaranteed the best possible reimbursement and care for your patients.

Correct use of G0296 will not only help in early detection of lung cancer, but it will also enable meaningful conversations on issues concerned with prevention and health maintenance. Through sufficient staff training, EHR incorporation, audit readiness, and emphasis on patient education, your practice can venture ahead and successfully move through the ever-changing world of preventative care.

FAQ - People Also Asks

No. G0296 is billable only for the first counseling visit pre-initial LDCT screening. Other follow up annual screenings require a written order, and not another visit for counseling.

Yes, but use modifier -25 to indicate a significant, separately identifiable service.

Do not bill G0296 if the patient does not meet all eligibility criteria.

Medicare will not cover the counseling or screening for patients outside the eligible age range.

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