Summary & Overview
HCPCS G0297: Low-Dose CT for Lung Cancer Screening
HCPCS Level II code G0297 denotes a low-dose CT (LDCT) scan performed specifically for lung cancer screening. This screening modality is a nationally recognized preventive service intended to detect early-stage lung cancer among eligible populations and has implications for population health management, screening programs, and imaging capacity planning.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what G0297 represents, why LDCT lung cancer screening matters at a national level, and what to expect when reviewing payer policies and coverage practices. The publication outlines typical settings where the service is delivered and highlights common billing considerations associated with outpatient radiology and hospital outpatient imaging services.
The report provides benchmarks and comparative coverage context, summarizes relevant policy updates and national screening guidance influencing utilization, and situates the code within clinical workflow for preventive oncology. Data not provided in the input are noted where applicable; the content focuses on the clinical and billing identity of the code and the payer landscape that shapes coverage for lung cancer screening with LDCT.
Billing Code Overview
HCPCS Level II code G0297 represents low dose CT scan (LDCT) for lung cancer screening. This service is a screening imaging procedure that uses low-dose computed tomography to detect early-stage lung cancer in eligible individuals. The service type is screening low-dose chest CT, and the typical site of service is outpatient radiology centers or hospital outpatient imaging departments.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 64-year-old current smoker with a 35 pack-year history presents for annual low-dose CT lung cancer screening. The patient has no acute respiratory complaints and is asymptomatic; screening is performed after shared decision-making and documentation of eligibility (age 50–80 with ≥20 pack-year history and currently smoking or quit within 15 years). The workflow: pre-authorization or benefit verification is completed when required by the payor; the patient is screened for contraindications (pregnancy, inability to lie supine); technologist confirms identity and screening indication; a low-dose, non-contrast chest CT protocol is obtained and transmitted to the radiology PACS; a radiologist interprets the study, documents Lung-RADS assessment and recommended follow-up; the professional component (interpretation) and technical component (scanner use, technologist) are coded separately when applicable; results are communicated to the referring clinician and the patient with follow-up plans for surveillance, diagnostic evaluation, or smoking cessation counseling as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
TC | Technical component | Use when billing only the facility/technical portion of the LDCT (scanner, technologist). |
26 | Professional component | Use when billing only the radiologist interpretation portion of the LDCT. |
52 | Reduced services | Use when the LDCT study is performed but reduced in scope or incomplete for clinical/technical reasons yet still reportable. |
53 | Discontinued procedure | Use when the LDCT is started but terminated due to patient-related issues and should be reported as discontinued. |
59 is not in the supplied list and therefore not included | Data not applicable | Data not applicable |
QX | Qualified non‑physician practitioner with assistant qualification | Use when a qualified non‑physician practitioner performs an authorized portion of the service under relevant rules with modifier QX appended. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Not typically used for LDCT; included in list; use only if anesthesia services meet criteria. |
QY | Attending provider disparity (e.g., when a non‑physician practitioner is billing under specific arrangements) | Use when required by payor rules for non‑physician billing circumstances. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Generally not applicable for LDCT imaging; include only for documentation when an advanced practitioner has a specific role per payor policy. |
CO | Casts and supplies — Modifier CO commonly reserved for specific payor reporting | Use per payor rules when reporting certain care components or cost-sharing adjustments as required. |
CQ | Service furnished by a PHS, Tribal, or otherwise exempt provider | Use when the LDCT is furnished by a federally funded/tribal provider and the payor requires this modifier. |
FY | Exception or unusual circumstance | Use per payor guidance when an unusual billing circumstance applies. |
FX | Service performed by an employee of a foreign government or international organization | Use when applicable for payer reporting requirements. |
SH | Physician providing stand‑by services | Use only if a physician was present in a stand‑by capacity as defined by payor rules. |
SJ | Split/shared E/M or other service designation per payor requirement | Use per payor rules when split/shared billing applies to associated professional services. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2084P0800X | Diagnostic Radiology | Primary specialty performing and interpreting G0297 LDCT screenings. |
207P00000X | Physician Assistant | May perform patient preparation, screening intake, and under supervision assist in care coordination. |
363A00000X | Radiologic Technologist | Performs the LDCT acquisition (technical component). |
207L00000X | Pulmonary Disease | Refers patients for LDCT screening and manages follow-up for abnormal results. |
2085R0202X | Interventional Radiology | May be involved if follow-up diagnostic procedures (biopsy, localization) are needed after positive screening. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z12.2 | Encounter for screening for malignant neoplasm of respiratory organs | Directly indicates lung cancer screening encounters and supports use of G0297. |
Z87.891 | Personal history of nicotine dependence | Documents smoking history relevant to screening eligibility and risk stratification. |
F17.210 | Nicotine dependence, cigarettes, uncomplicated, in remission | Captures nicotine dependence status which affects screening intervals and counseling. |
F17.211 | Nicotine dependence, cigarettes, in remission, in a controlled state | Alternative capture for smoking history/status when applicable. |
R91.8 | Other nonspecific abnormal finding of lung field | May be used for subsequent diagnostic follow-up when LDCT detects indeterminate nodules requiring surveillance. |
C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung | Used when screening identifies suspicious lesions that are later diagnosed as lung cancer and transitioned to diagnostic/oncologic care. |
Z71.6 | Tobacco abuse counseling | Used when counseling or cessation interventions are provided as part of the screening program. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
71250 | Computed tomography, thorax; without contrast material | Often used as the technical CPT equivalent for low‑dose, non‑contrast chest CT when a CPT is required for reporting technical services or internal billing. |
71260 | Computed tomography, thorax; with contrast material | Performed when a screening LDCT yields findings that require a diagnostic CT with contrast for further evaluation. |
71270 | Computed tomography, thorax; without contrast followed by contrast | Used when both non‑contrast and contrast sequences are performed in a single encounter following screening abnormalities. |
74177 is not chest-specific and therefore not included | Data not applicable | Data not applicable |
88305 | Level IV surgical pathology, gross and microscopic examination | May be used later if tissue obtained after a positive LDCT requires pathologic evaluation. |
94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | Not typically related to screening; included only if acute respiratory treatment is provided during the visit per clinical need. |
If additional facility‑level CPT coding is required for local billing, mapping to the appropriate CT chest CPT for technical components and to interpretation CPTs or HCPCS for screening should be applied per institutional billing guidance and payor policy.