Aetna Lung Cancer Screening coverage criteria

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

Coverage criteria

• Annual low-dose computed tomography (LDCT) scanning (also known as spiral CT or helical CT scanning) is medically necessary for current or former smokers when ALL of: ages 50 to 80 years AND a 20 pack-year or more smoking history AND, if a former smoker, has quit within the past 15 years.
• Annual LDCT is medically necessary for surveillance (starting 2 years after definitive treatment) of individuals with non-small cell lung cancer who have undergone definitive treatment.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

• 71271·PA verdict·Rate
• G0296·PA verdict·Rate

Frequently asked questions

When does Aetna cover Lung Cancer Screening (CPT 71271), and what gets it denied?

Aetna covers annual low-dose CT (LDCT) lung cancer screening for current or former smokers aged 50-80 with at least a 20 pack-year history who, if they quit, did so within the past 15 years, and also covers annual LDCT surveillance starting 2 years after definitive treatment for people treated for non-small cell lung cancer. LDCT for any other screening indication (e.g., asbestos exposure), as well as AI-based imaging, computer-aided detection of chest radiographs, and PET for lung cancer screening, are considered experimental/investigational and not covered. Coverage criteria include: Annual low-dose computed tomography (LDCT) scanning (also known as spiral CT or helical CT scanning) is medically necessary for current or former smokers when ALL of: ages 50 to 80 years AND a 20 pack-year or more smoking history AND, if a former smoker, has quit within the past 15 years.; Annual LDCT is medically necessary for surveillance (starting 2 years after definitive treatment) of individuals with non-small cell lung cancer who have undergone definitive treatment.. Applies to 2 codes: 71271, G0296. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Experimental, investigational, or unproven (effectiveness not established): Artificial intelligence-based imaging for lung cancer screening.; Experimental, investigational, or unproven (effectiveness not established): Computer-aided detection for chest radiographs for screening or diagnosis of lung cancer and for all other indications. There is presently inadequate evidence in the medical literature that population-based mass lung cancer screening with computer-aided detection for chest radiographs will contribute substantially to the detection of smaller cancers, or decreases mortality.; Experimental, investigational, or unproven (effectiveness not established): LDCT as a screening test for all other indications not listed in Section I (e.g., asbestos-exposed individuals). Note: this does not apply to lung cancer surveillance.; Experimental, investigational, or unproven (effectiveness not established): Positron emission tomography (PET) for lung cancer screening. Claims may be denied when the requested service falls under these.

Does Aetna require prior authorization for Lung Cancer Screening?

Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.

What does Aetna exclude for Lung Cancer Screening?

Policy exclusions and limitations: Experimental, investigational, or unproven (effectiveness not established): Artificial intelligence-based imaging for lung cancer screening.; Experimental, investigational, or unproven (effectiveness not established): Computer-aided detection for chest radiographs for screening or diagnosis of lung cancer and for all other indications. There is presently inadequate evidence in the medical literature that population-based mass lung cancer screening with computer-aided detection for chest radiographs will contribute substantially to the detection of smaller cancers, or decreases mortality.; Experimental, investigational, or unproven (effectiveness not established): LDCT as a screening test for all other indications not listed in Section I (e.g., asbestos-exposed individuals). Note: this does not apply to lung cancer surveillance.; Experimental, investigational, or unproven (effectiveness not established): Positron emission tomography (PET) for lung cancer screening. Claims may be denied when the requested service falls under these.

Source

Related

• All Aetna coverage policies
• Aetna prior-authorization requirements — which codes need PA, by CPT