Lung cancer CT scans

Applies to:

All plans

Definition:

Priority Health covers an annual CT scan for lung cancer as a preventive benefit. Specific age and smoking status criteria must be met.

Preventive lung cancer CT scan authorization

Patients must meet eviCore healthcare criteria for the service to be covered as preventive.

Participating providers request authorization by using our Auth Request tool to enter the CPT code. You'll be transferred to eviCore healthcare to complete your request.

Non-participating providers:

  • In-state providers should call eviCore healthcare for authorization: 844.303.8456.
  • Out-of-state providers should call us to check benefits and authorizations at 833.300.3628.

Pre-service education is required

Before we'll authorize payment, providers must complete a counseling and shared decision making* visit with the patient, including the use of one or more decision aids such as Emmi® or Option Aid, to discuss the benefits and risks of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure.

Patients affected

Pre-service education is required for:

  • Group and individual HMO, EPO, POS and PPO plan members
  • Medicare plan members
  • Medicaid and Healthy Michigan Plan members

To order the Emmi program for your patients

There are three options for you to help your patients complete their pre-service education through Emmi®:

  1. Order the program on the Emmi® website. Enter your patient's information and email address, and the program will be automatically emailed to your patient for them to complete. Note: The program will start automatically. To close it, click the "View Program" button.
  2. Give patients without an email address a copy of the self-registration handout. The handout will tell your patient how to complete the education online.
  3. If patients don't have internet access, consider providing a workstation at your office where they can complete the education.

Authorization documents and links

*Shared decision making is a collaborative process where the provider helps the patient understand the decision and its consequences, and then helps them apply their values and preferences in order to make a decision.

Lung cancer screening billing

For the preventive screening: Bill code G0297

For counseling: Bill code G0296