Practice Management

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  • 1.  LDCT coverage

    Posted 05-25-2021 15:09
    Have there been any updates regarding Medicare coverage of LDCTs? And at an IDTF?   
    WPS has not been covering LDCTs as preventative since the introduction of the new code, 71271, on Jan 1.  I could not find any current coverage documents from WPS but found local coverage article A58641 from Palmetto.  Palmetto just reprocessed all of our Railroad Medicare LDCTs to cover at 100%.  Should I expect the other MACs to follow?

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    Amber Stephenson
    Office Manager
    Manhattan Radiology
    Manhattan KS
    (785) 539-7641
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  • 2.  RE: LDCT coverage

    Posted 05-27-2021 16:27

    Hi Amber,

    WPS does not have an LCD/Billing and Coding Article for CPT 71271 so they should be following NCD 210.14 – National Coverage Determination for Lung Cancer Screening with Low Dose Computed Tomography (LDCT)

     

    Are you billing with one of the approved diagnosis codes listed below based from the NCD?

     

    F17.210, F17.211, F17.213, F17.218, F17.219 or Z87.891.

     

    If so, you should be receiving payments from WPS just as we are.

     

    Hope this helps.

     

    Kim Smiley, CPC, RCC

    Coding Manager

    ph:  (317) 328-7256  |  fax: (317) 715-9955

    kim@northwestradiology.com

     

    Description: Description: Description: Description: NWR_50YR_Color_small

     

     

     

     




    Original Message


  • 3.  RE: LDCT coverage

    Posted 05-28-2021 07:58
    We also use WPS as our Medicare provider. We noticed that they were applying to patient's deductible so i have done redeterminations on some. No response yet. They are processing them though with Z122 and a smoking Dx.

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    Jackson Radiology Consultants, PC
    PO Box 905
    Jackson, MI
    Work: (517) 783-2612
    Fax: (517) 783-6095
    Mary@jacksonradiology.net
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    Original Message


  • 4.  RE: LDCT coverage

    Posted 06-01-2021 09:26
    Just to confirm for all:  Palmetto (Georgia's Medicare payer) originally adjudicated our 71271 claims and pushed amounts towards deductible and coinsurance earlier in the year.  This was being done as late as mid-April 2021.  They have since reprocessed all claims as preventive care and taken back and paid all amounts which were previously sent to deductible and coinsurance.

    FYI.....Chris

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    R. Christopher Sluder CPA
    Administrator
    Rome Radiology Group
    Rome GA
    (706) 291-2661
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    Original Message


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