American College of Radiology issues heads-up on possible payment denials at certain facility types

The American College of Radiology issued a heads up on Thursday regarding potential payment denials at certain facility types.

ACR highlighted the delivery of low-dose CT lung cancer screening at independent diagnostic testing facilities. Following a positive coverage determination for the specialty last year, Medicare is required to pay for such exams in these settings, provided that proper criteria are met. Same goes for both Medicaid and commercial insurance, the college emphasized on April 27.

“The ACR recommends [independent diagnostic testing facilities] that experience Medicare claim denials or billing challenges contact their Medicare Administrative Contractor and/or download the IDTF billing and coding article for their MAC region,” the update noted.

Such facilities also can remedy these billing challenges by updating their Medicare enrollment application to include the CPT code 71271 (CT, thorax, low-dose for lung cancer screening without contrast). CMS also offers a booklet with details on how independent diagnostic testing facilities can enroll in the Medicare program.

ACR noted that last year, the feds quashed a requirement that radiology facilities must offer smoking cessation interventions in order to receive payment for LDCT, eliminating a key screening barrier.

“The removal of this requirement expands access to lung cancer screening by increasing accessibility in an IDTF setting,” the update noted. “The American College of Radiology applauds CMS for streamlining the process to allow IDTFs the ability to perform and receive reimbursement for lung cancer screening.”