These services may or may not be covered by all CoOportunity Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.
Administrative process
Annual low-dose computed tomography for lung cancer screening does not require prior authorization.
CoOportunity Health encourages and expects our providers to follow the American College of Radiology (ACR) Appropriateness Criteria®. Please see related content at the right for link to ACR criteria.
Coverage
Annual low-dose computed tomography for lung cancer screening is covered as a preventive benefit according to the indications below, and your plan documents.
Indications that are covered at Preventive Benefit level
The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in persons age 55 through 80 years with a 30 pack-year history of smoking who are currently smoking or have quit within the past 15 years.
Indications not covered under Preventive Benefit level
- Members outside the age limits as stated above.
- Members without the smoking history as stated above.
- Once the individual has not smoked for 15 years or develops a health problem significantly limiting either life expectancy or ability or willingness to undergo curative lung surgery.
Definitions
Pack-year: A way to measure the amount a person has smoked over a long period of time. It is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, 1 pack year is equal to smoking 1 pack per day for 1 year, or 2 packs per day for half a year, and so on.
From the National Cancer Institute
Codes
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
| Code | Description |
|---|---|
| 71250 | Computed tomography, thorax; without contrast material |
| S8032 | Low-dose computed tomography for lung cancer screening |
CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Portions of this policy were taken directly from the USPSTF Screening for Lung Cancer guideline and the National Cancer Institute.
This information is for most, but not all, CoOportunity Health plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.