HCPCS Code G0297: Low-Dose CT Lung Cancer Screening

Key takeaways

HCPCS Code G0297 described a low-dose CT scan (LDCT) for lung cancer screening. It was billable for dates of service from February 5, 2015 through December 31, 2020.

CMS end-dated G0297 on December 31, 2020 and replaced it with CPT 71271 effective January 1, 2021, under CR 12124.

Some references date the switch to January 2022. In fact, that date belongs to a separate CMS instruction on cost-sharing, not to the code replacement.

Medicare requires Z87.891 or an F17.21x cigarette dependence code on the claim line. However, Z12.11 alone does not clear the NCD 210.14 edit.

The frequency limit is one screening per year with at least 11 full months since the last scan. Still, it is not a calendar-year reset.

Practice management software like Pabau holds procedure codes centrally, so a retired code stops reaching new claims.

HCPCS Code G0297: definition and code details

HCPCS Code G0297 was the Medicare code for a low-dose computed tomography (LDCT) scan used to screen for lung cancer. In fact, it was billable for almost six years, until CMS end-dated it and moved the service to CPT 71271. Even so, coders still meet G0297 on historical claims, remittances, and audit requests.

The transition date matters, and it is widely published wrong. Specifically, G0297 was end-dated December 31, 2020, and CPT 71271 took over on January 1, 2021. However, several coding references and vendor code lists put the change a year later, in January 2022. Instead, that later date belongs to a different CMS instruction, covered further down this page.

This guide covers the code descriptor, the correct deletion timeline, and the crosswalk to CPT 71271. It also covers Medicare eligibility, companion code G0296, required ICD-10 codes, modifiers, reimbursement, documentation, and the denial codes contractors apply.

G0297 was a HCPCS Level II G-code. In practice, CMS uses that range for services it needs to pay for before the AMA CPT code set issues a permanent code. When CPT 71271 arrived in the 2021 CPT code set, CMS end-dated G0297 to remove the duplicate. As a result, every billing workflow that processed G0297 had to switch on January 1, 2021.

G0297 code history and deletion timeline

Medicare began covering LDCT lung cancer screening on February 5, 2015, under National Coverage Determination 210.14. G0296 and G0297 gave billers Medicare-specific codes while the AMA developed a permanent CPT code. The two codes did not reach the claims processing systems until January 4, 2016, so the first year of claims was submitted retroactively.

Transmittal 10906 is where the confusion starts. Specifically, its background section states plainly that G0297 was replaced with 71271 effective January 1, 2021. Meanwhile, the instruction it carries waives coinsurance and deductible on institutional claims. However, it is effective January 1, 2022 for dates of service on or after January 1, 2021. As a result, reading only that second date produces the 2022 replacement claim you will find on many coding sites. The visual below marks which of those two dates changed the code.

A claim submitted with G0297 for a date of service on or after January 1, 2021 is denied. By contrast, claims for dates of service from February 5, 2015 through December 31, 2020 remain valid under G0297. As a result, denial management work on this code is now limited to appeals, reopenings, and audit responses.

Crosswalk: HCPCS Code G0297 to CPT 71271

The crosswalk from G0297 to CPT 71271 is a direct one-to-one replacement. In fact, both codes describe the same procedure, the same patient population, and the same Part B preventive benefit. Still, only the code number and the issuing authority changed.

CPT 71271 also travels better outside Medicare. Many commercial payers never loaded HCPCS G-codes, so G0297 claims needed manual handling. For the current rules on the successor code, see our guide to CPT code 71271. The diagnostic chest CT codes 71250, 71260, and 71270 are not substitutes, because they describe diagnostic imaging rather than screening. For historical verification of a G0297 line, the AAPC HCPCS code lookup still carries the retired entry.

Medicare eligibility criteria for lung cancer screening

Medicare covers LDCT screening for patients aged 50 to 77 with at least a 20 pack-year smoking history. In other words, those are the current NCD 210.14 criteria, effective for dates of service on or after February 10, 2022. By contrast, every G0297-era claim was judged against a stricter set of rules.

Confirm all of the following before billing CPT 71271. However, a historical HCPCS Code G0297 claim is judged against the criteria that applied on its own date of service:

• Age 50 to 77 years at the time of service
• Asymptomatic, with no signs or symptoms of lung cancer
• A tobacco smoking history of at least 20 pack-years
• A current smoker, or a former smoker who quit within the last 15 years
• An order for lung cancer screening with LDCT
• A counseling and shared decision-making visit before the first screening, billed under G0296

The upper age limit is the detail most often misreported. The USPSTF recommends screening through age 80, but Medicare stops at 77. A claim for a 78-year-old patient rejects on the age edit in the Common Working File, even though the patient meets the USPSTF recommendation.

Practices that never revisited their eligibility rules after February 2022 are still screening out patients Medicare now covers. For example, a 52-year-old with 22 pack-years fails the old rule and passes the current one.

Companion code G0296: shared decision-making counseling

G0296 pays for the counseling and shared decision-making visit Medicare requires before a patient’s first LDCT scan. It is a coverage condition rather than optional paperwork. In practice, the visit has to happen before the first screening and be documented in the medical record.

A complete superbill for a new screening patient carries G0296 on the counseling date and CPT 71271 on the scan date. Therefore, both dates need to be visible to whoever submits the claim.

ICD-10 diagnosis codes required with G0297 and CPT 71271

Medicare requires a tobacco-related ICD-10 code on the claim line, not a screening encounter code. Specifically, NCD 210.14 lists Z87.891 plus five cigarette dependence codes in the F17.21x range. As a result, a claim line without one of them is denied under CARC 167.

This runs against what many coding guides advise. Z12.11 describes an encounter for screening of the bronchus and lung, so it reads like the obvious first-listed code. It does not appear on the covered diagnosis list for this NCD, so it does not clear the edit on its own.

In fact, the requirement has applied to dates of service on or after October 1, 2015, and it did not change when 71271 replaced G0297. For instance, reporting Z12.11 alongside Z87.891 or an F17.21x code is fine. By contrast, reporting Z12.11 and omitting the tobacco code is what triggers the denial. Check code validity with the CDC ICD-10-CM search tool, and confirm the descriptor against our ICD-10-CM code index before the claim goes out.

Billing guidelines and frequency limitations for HCPCS Code G0297

Medicare allows one LDCT screening per year, and at least 11 full months must elapse after the last scan. In other words, that is not a calendar-year reset. For example, a patient scanned in March 2025 becomes eligible again in March 2026, not on January 1.

• Frequency: One screening per year, with at least 11 full months after the previous scan. The Common Working File edit is overridable, so a documented exception can still be paid.
• Type of bill: Institutional claims are payable only on TOB 12X, 13X, 22X, 23X, 71X, 77X, and 85X. Otherwise, other bill types are denied under CARC 170.
• Place of service: Hospital outpatient departments and freestanding radiology facilities both qualify. In addition, the facility has to use a standardized lung nodule identification, classification, and reporting system.
• Reading radiologist: Board certification or board eligibility with the American Board of Radiology, or an equivalent organization.
• Patient cost-sharing: Medicare waives the Part B deductible and coinsurance on both the screening and the G0296 counseling visit.
• Advance beneficiary notice: Issue an ABN when the patient falls outside the coverage criteria, then append the matching liability modifier.

Sound revenue cycle management for radiology and pulmonology teams puts the 11-month check before the booking, not after the denial. For instance, confirming the last screening date at scheduling costs a few seconds. By contrast, reworking a CARC 119 denial costs a great deal more.

Modifiers used on LDCT screening claims

The screening service itself needs no modifier. Instead, modifiers appear on LDCT claims for two reasons: splitting the professional and technical components, and flagging patient liability when coverage is in doubt.

The difference between GA and GZ is money. Specifically, with a signed ABN and modifier GA, the practice can bill the patient for a denied scan. With GZ, by contrast, CMS assigns the write-off to the provider, so the practice absorbs the cost of the scan.

How CPT 71271 is paid now that G0297 has retired

G0297 has no current payment rate, because it stopped being payable after December 31, 2020. By contrast, CPT 71271 is paid according to the setting, like other imaging codes. For example, physician offices and freestanding facilities are paid under the Medicare Physician Fee Schedule. Meanwhile, hospital outpatient departments are paid under OPPS through an ambulatory payment classification.

The professional and technical split follows the same logic. For example, a radiologist reading for a hospital bills 71271 with modifier 26 under the fee schedule. Meanwhile, the hospital bills the technical side on its own institutional claim.

Rates change each year and by locality, so look them up rather than quoting a national figure. The CMS Physician Fee Schedule Look-Up Tool carries the professional and freestanding rates. Meanwhile, OPPS Addendum B carries the hospital outpatient rate.

One rule holds across every setting. Coinsurance and the Part B deductible are waived on 71271, because it is an additional preventive service with a USPSTF Grade B recommendation. CMS still had to issue a separate instruction in January 2022 to make that waiver work on TOB 22X, 23X, 71X, 77X, and 85X claims. In fact, that instruction is the one so often misread as the code replacement date.

Documentation requirements for G0297 and CPT 71271 claims

The documentation rules changed with the February 2022 reconsideration, and many coding references still publish the old list. Under the 2015 NCD that governed HCPCS Code G0297, the written order had to carry five named elements. By contrast, the current NCD asks only that the patient receive an order for LDCT screening.

Hold the following in the record for a claim submitted today:

• Order for LDCT screening: The current NCD no longer specifies its contents. Contractors still expect to see who ordered the scan and when.
• Counseling visit record: Documentation of the G0296 visit, including its date and the four required discussion elements.
• Quantified smoking history: Record pack-years as a number, such as 22 pack-years, rather than a phrase such as heavy smoker.
• Age on the date of service: The patient has to be 50 to 77 years old on the scan date.
• Final radiologist report: A preliminary read does not support the claim.
• Standardized nodule reporting: The imaging facility has to use a standardized lung nodule identification, classification, and reporting system. In practice, Lung-RADS is the common choice.

Structured reporting is a coverage condition on the facility, not a payer preference. For example, a facility that reports nodules in free text fails an NCD requirement, whatever the claim looks like.

Paper intake and ordering workflows are where the pack-year number and the counseling date go missing. By contrast, digital intake forms that require a numeric pack-year field remove the most common documentation failure on this service. In short, a checklist tied to the order beats an audit after the scan.

Common denial reasons on LDCT screening claims

CMS publishes the exact reason codes its contractors apply to lung cancer screening denials. Reading the CARC on the remittance tells you which edit fired, so the fix becomes mechanical instead of guesswork.

Two of these never need to reach billing at all. In fact, the age check and the 11-month check both use data the practice already holds. In short, a high clean claim rate on screening work is mostly a scheduling discipline.

How practice management software supports LDCT screening billing

The G0297 retirement exposed an operational weakness. Specifically, billing teams working from static code lists had to update superbill templates and charge capture tools by hand. As a result, practices with no workflow-level enforcement kept submitting G0297 into 2021, until the denials told them to stop.

Practice management software like Pabau reduces that exposure by holding procedure codes in one place. For example, an administrator retires a code once, and every service template picks up the change. The same record supports the frequency check, because the system already knows when a patient last had the scan.

Sequencing is the other place software helps. When the G0296 counseling visit has to be recorded before the scan appointment is finalized, the ordering rule gets enforced at booking. A coverage condition becomes a step someone has to complete, rather than a denial someone has to explain later. In short, Pabau’s billing tools support cleaner claims management, submitting and tracking the claim from the same patient record.

Stop chasing code transitions manually

Pabau’s billing workflow tools help radiology and preventive care practices track procedure code changes, verify eligibility, and submit clean claims for LDCT screening. See how Pabau keeps your claims accurate as codes evolve.

Book a demo

Conclusion

HCPCS Code G0297 stopped being billable after December 31, 2020, and CPT 71271 has carried LDCT lung cancer screening since January 1, 2021. If a reference dates the switch to January 2022, it has confused the code replacement with a separate cost-sharing instruction. In short, the crosswalk itself is direct, and the coverage rules moved across unchanged.

Three details cause most denials on this service today. First, the claim line needs Z87.891 or an F17.21x code. Second, the G0296 counseling date has to precede the first scan. Third, the 11-month frequency window is not a calendar year. Pabau’s claims management tools support procedure code tracking, eligibility checks, and clean claim submission, so coders work from current codes rather than last year’s templates. To see how Pabau handles a code transition like this one, book a demo.

Continue your research

Need a framework for medical billing compliance? Medical billing compliance covers the documentation and workflow standards that keep preventive service claims payable.

Want to reduce claim denials before they happen? Clean claim submission practices outlines the pre-submission checklist that prevents the most common denial patterns.

Managing revenue across multiple providers? Revenue cycle management fundamentals explains how to connect scheduling, documentation, and billing into a single compliant workflow.

Frequently asked questions