CPT Code 71271: Low-dose CT lung cancer screening

Key Takeaways

CPT Code 71271 describes a low-dose CT (LDCT) scan of the thorax performed for annual lung cancer screening in high-risk patients.

Medicare covers this code annually for patients aged 50-77 with a 20 pack-year smoking history who are current smokers or quit within the past 15 years.

HCPCS G0296 (shared decision-making visit) must be billed before the first annual LDCT screening; subsequent annual screenings do not require a repeat G0296.

Pabau’s claims management software helps radiology and primary care practices document eligibility criteria, track G0296 completion, and submit LDCT claims accurately.

Missed eligibility documentation is the top reason CPT Code 71271 claims get denied. Medicare’s lung cancer screening benefit has strict requirements: age, smoking history, symptom status, and a completed shared decision-making visit must all be confirmed before you submit. Skip any one of them and the claim comes back unpaid.

This reference guide covers what CPT Code 71271 is, who qualifies under Medicare, how to pair it with the right ICD-10 codes, current reimbursement rates, applicable modifiers, and the documentation checklist that keeps claims clean. It also covers commercial payer rules and the most common denial patterns billers encounter.

CPT Code 71271: Definition and clinical description

CPT Code 71271 is assigned to computed tomography (CT) of the thorax, low dose, for lung cancer screening, without contrast material. The American Medical Association maintains this code in the AMA’s CPT code set, categorizing it within the Diagnostic Radiology section.

Low-dose CT delivers significantly less ionizing radiation than a diagnostic chest CT, typically 1-2 millisieverts versus 7-8 mSv for a full diagnostic scan. The procedure takes fewer than 10 minutes and requires no intravenous contrast. It images the lungs, mediastinum, and surrounding thoracic structures well enough to detect nodules as small as a few millimeters.

The clinical rationale is strong. The National Lung Screening Trial found that annual LDCT reduced lung cancer mortality by 20% in high-risk populations compared with chest X-ray.

That trial directly supported the U.S. Preventive Services Task Force (USPSTF) issuing a Grade B recommendation for LDCT screening, which in turn triggered the ACA coverage mandate for commercial insurers and Medicare coverage through CMS National Coverage Determination (NCD) 210.14.

Medicare eligibility criteria for CPT Code 71271

CMS updated the Medicare lung cancer screening eligibility criteria in February 2022 via a revision to NCD 210.14, expanding the age range from 55-77 to 50-77. That change brought Medicare’s criteria into alignment with the USPSTF’s 2021 updated recommendation. Confirm the current NCD text at CMS’s Physician Fee Schedule before billing for any patient near the age boundaries.

All five criteria below must be documented in the medical record before billing CPT Code 71271. A single missing element can trigger a medical necessity denial.

Practices that manage multiple preventive screenings can benefit from structured eligibility checklists embedded directly in their digital intake forms, so no criterion is overlooked before the order is placed.

Shared decision-making requirement: HCPCS G0296

HCPCS G0296 is the companion code for the shared decision-making (SDM) counseling visit that CMS requires before a beneficiary’s first annual lung cancer screening. Without a G0296 on file for the first-time screen, Medicare will deny the 71271 claim.

The G0296 visit must cover specific content. CMS requires the clinician to:

• Discuss the benefits, limitations, and harms of LDCT screening
• Record the patient’s smoking history
• Document follow-up and referral plans if nodules are found

The visit can be performed by a physician, nurse practitioner, physician assistant, or clinical nurse specialist.

A critical nuance: G0296 is only required before the first annual screening. Subsequent annual screenings do not require a repeat SDM visit. Billing G0296 every year is incorrect and may trigger an audit flag. Structured compliance tracking tools help practices flag whether a patient has already had a qualifying G0296 visit before generating a new order.

G0296 billing guidance

• Bill G0296 on the same date of service as the SDM visit, separate from the E/M code for that visit
• G0296 can be billed by the ordering provider or facility that performs the SDM visit
• No modifier is needed for G0296 on its own. It’s covered as a preventive benefit with no cost-sharing for the beneficiary
• Document the SDM note separately from the general visit note. Payers may request it on audit
• Once G0296 is billed for a patient’s first screening cycle, record the date in the patient record to avoid duplicate billing in future years

ICD-10 diagnosis codes to pair with CPT 71271

Accurate diagnosis code pairing is essential for claim acceptance. Medicare requires at least one ICD-10 code that establishes medical necessity for a preventive lung cancer screening. Using the wrong code (such as a sign or symptom code rather than a screening code) will misclassify the service as diagnostic, changing the patient’s cost-sharing responsibility and potentially triggering a denial.

Use the CrossCoder CPT-to-ICD-10 crosswalk tool to verify current payer-accepted pairings before submitting. Some Medicare Administrative Contractors (MACs) publish Local Coverage Determinations (LCDs) that specify acceptable ICD-10 codes for 71271 in their jurisdiction. Always check your MAC’s LCD in addition to the national NCD.

CPT 71271 reimbursement rates

Medicare reimbursement for CPT Code 71271 is calculated from the CMS Physician Fee Schedule (PFS), which updates annually each January. The rates below reflect general 2025 figures based on CMS PFS data. Verify current amounts using the FastRVU lookup tool or the CMS PFS search before billing, as rates change year to year and vary by geographic region.

Geographic Practice Cost Indices (GPCIs) adjust these national averages by locality. A radiology practice in Manhattan will receive a higher payment than one in rural Mississippi for the same code. Actual payments may also vary based on whether the practice has accepted Medicare assignment.

Medicare covers CPT Code 71271 with no cost-sharing for the beneficiary when all eligibility criteria are met. That zero-cost-share status applies only to the screening service itself.

If a nodule is found and a follow-up diagnostic CT is ordered, that subsequent scan carries standard Medicare cost-sharing rules and would be billed under a different CPT code (such as 71250 or 71270).

Applicable modifiers for CPT Code 71271

Applying the wrong modifier (or omitting a required one) on a CPT Code 71271 claim is one of the fastest routes to a denial or a reduced payment. The modifiers below are the ones coders encounter most often for LDCT lung cancer screening.

A note on modifiers LT and RT: these laterality modifiers do not apply to 71271. A CT of the thorax images both lungs simultaneously, and appending LT or RT to this code is an error that can trigger a claim rejection.

Use the AAPC CPT code reference to review modifier applicability for radiology codes if you have questions about a specific scenario.

Keep your LDCT billing accurate and audit-ready

Pabau's claims management workflows help radiology and primary care practices track eligibility criteria, monitor G0296 completion status, and submit cleaner claims for preventive services like CPT 71271.

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Documentation requirements for billing CPT 71271

A clean 71271 claim depends on documentation assembled before the patient ever enters the scanner. Medicare audits for this code commonly focus on whether the medical record demonstrates each eligibility element independently, not just infers it. Radiology practices that rely on a referring physician’s order alone, without verifying the clinical details, carry significant audit risk.

The following checklist reflects CMS NCD 210.14 requirements. Practices using structured medical documentation forms can embed each element as a required field, making incomplete records impossible to submit.

• Physician or qualified NPP order: Written order specifying the LDCT for lung cancer screening, signed by a licensed physician, NP, PA, or CNS
• Age confirmation: Date of birth verified; patient falls within the 50-77 age range as of the date of service
• Pack-year calculation: Number of packs per day multiplied by years smoked, documented to confirm minimum 20 pack-years
• Smoking status: Current smoker, or former smoker with documented quit date within 15 years of the screening date
• Asymptomatic status: Clinician note confirming no current signs or symptoms of lung cancer (hemoptysis, unexplained weight loss, new cough, etc.)
• G0296 completion record: SDM visit note documenting benefits, harms, follow-up protocol discussion, and patient acknowledgment (required for first annual screening only)
• Lung-RADS report: Radiologist’s report structured to the American College of Radiology Lung-RADS reporting standard; documents nodule findings, Lung-RADS category, and follow-up recommendations

Practices integrating claims management software can automate pre-submission checks that flag missing documentation before a claim is transmitted, significantly reducing denial rates for preventive service codes like CPT Code 71271. Pairing this with HIPAA-compliant documentation workflows also protects patient data through the billing process.

Commercial and private payer coverage

Under ACA Section 2713, commercial health plans subject to the Affordable Care Act must cover USPSTF Grade B preventive services without cost-sharing. Because LDCT lung cancer screening holds a USPSTF Grade B recommendation, most commercial insurers cover CPT Code 71271 at no cost to the patient, provided the patient meets the eligibility criteria.

Coverage details vary by payer and plan type. Grandfathered health plans (those that existed before the ACA and have not made significant changes) are not required to comply with the cost-sharing waiver. Self-insured ERISA plans may have different obligations. Short-term health plans are generally exempt from ACA preventive service requirements.

Key commercial payer considerations

• Prior authorization: Varies significantly by payer. Some commercial insurers require prior auth for LDCT even when it meets USPSTF criteria. Always check the payer’s policy before scheduling. See Pabau’s primary care compliance checklist for broader prior auth workflows.
• Modifier 33: Some commercial payers require modifier 33 (Preventive Service) on the 71271 claim to signal the ACA cost-sharing waiver applies. This is payer-specific; verify before applying.
• Network status: Facilities performing LDCT must be in-network for the cost-sharing waiver to apply. Out-of-network LDCT scans may carry standard cost-sharing even if the service is preventive.
• Age range variation: Some commercial plans have adopted broader eligibility (beginning at age 50) while others retain the older USPSTF threshold. Confirm the plan’s current policy directly.

Common billing errors and denial prevention

Denial patterns for CPT Code 71271 are predictable. The same five errors appear repeatedly across billing departments, and each one is preventable with the right workflow controls in place. Practices that automate their pre-claim verification catch most of these before transmission.

How Pabau supports LDCT lung cancer screening billing

Billing CPT Code 71271 accurately requires managing several interdependent steps: confirming eligibility before the scan, tracking G0296 completion status, pairing the right ICD-10 codes, and ensuring the documentation package is complete before claim transmission. A disorganized workflow at any of these points generates denials.

Pabau’s claims management tools help practices build pre-submission checklists tied to specific procedure codes, so the billing team can see at a glance whether all required elements are in place before a 71271 claim goes out.

Digital intake forms can capture smoking history, pack-year calculations, and symptom status at the point of scheduling, feeding directly into the patient record rather than requiring manual re-entry at the billing stage.

Practices running preventive screening programs also benefit from Pabau’s automated recall workflows, which can flag patients due for their annual LDCT renewal and prompt the scheduling team before a screening opportunity is lost.

For practices focused on keeping patient data secure through the billing process, Pabau’s HIPAA-aligned architecture supports the documentation standards CMS expects for preventive service claims.

Primary care practices and IDTFs interested in streamlining their preventive radiology billing can explore how practice management software integrates coding, documentation, and claims into a single workflow. The result: fewer denied claims, faster reimbursement, and a cleaner audit trail for every CPT Code 71271 submission.

Conclusion

CPT Code 71271 is a high-value preventive service code, but its billing requirements leave little room for error. Missing the G0296, pairing the wrong ICD-10, or submitting without verified eligibility documentation all produce the same result: a denied claim and revenue recovery work that could have been avoided.

Pabau’s digital forms and documentation workflows help practices capture every eligibility criterion at the point of scheduling, not at the billing stage where corrections are expensive. To see how Pabau handles preventive service billing workflows, book a demo with the team.

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