Lung Cancer Screening

Guidance for Referring Providers 

The only recommended screening procedure for lung cancer is low-dose computed tomography testing (LDCT). Please see below for information on patient eligibility, LDCT referral instructions, billing, insurance coverage and other resources.

Patient Eligibility

Before ordering the LDCT screening test the ordering provider must ensure that all eligibility criteria have been met and documented in the medical record. If the provider answers “no” to any of the criteria below, the patient’s insurance may not cover the exam. In the event that the criteria are not met and the patient would still like to have a lung screening, the exam could be completed as a self-pay. Screening should be discontinued once a person has not smoked for 15 years.

  • The patient is between the ages of 55 – 80 (55-77 for Medicare).
  • The patient is asymptomatic (no signs or symptoms of lung cancer).
  • The patient has a tobacco history of at least 30 pack years. (One pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes.)
    • Smokingpackyears.com is an easy-to-use online pack year calculator that calculates variations in smoking history.
  • The patient currently smokes or quit within the last 15 years.
    • If currently smoking, smoking treatment and counseling must be offered to the patient and documented in the medical record.
      • View the "Tobacco HelpLine Referral Instructions and Talking Points" section on this page for more information
      • NOTE: Additional tobacco treatment resources may be available in your region, including individual counseling or group support.
    • If the patient is a former smoker (quit tobacco use within the last 15 years), counseling should be provided on the importance of maintaining cigarette smoking abstinence.
  • The patient has had a shared decision making (SDM) conversation with a physician or qualified non-physician practitioner, including the use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure. SDM conversations must be documented in the patient’s medical record. For an example of a shared decision making aid, click here.
    • A qualified non-physician practitioner is a physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the Social Security Act.
    • NOTE: If referring to the Maine Medical Center Lung Cancer Screening Program in Scarborough, the referring provider does not need to conduct the SDM conversation or smoking cessation conversation with the patient as these will be performed as part of the screening.
  • The patient does not have a health problem that substantially limits life expectancy or the ability to undergo diagnosis and treatment.
  • The patient is willing to undergo diagnosis and treatment, if appropriate.
  • The patient has been counseled on the importance of adherence to annual lung cancer LDCT screening.

LDCT Referral Instructions

LDCT can be ordered by a practitioner or specialized lung cancer screening program. Written orders for LDCT must be appropriately documented in the patient’s medical record by the ordering provider.

Lung cancer screening is offered at many MaineHealth system and affiliate locations. The referral process may vary by location. 


 Refer to the Billing and Insurance Coverage Information section on this page for guidance on billing and coding. 

Billing and Insurance Coverage

Encourage patients to contact their insurance provider regarding coverage. Annual lung cancer screening with LDCT is recommended by the US Preventive Services Task Force (USPSTF) and is generally covered by the Centers for Medicare and Medicaid Services (CMS) and many private health insurance companies for qualified patients.

Health Care Common Procedure Coding System (HCPCS) Codes:

  • G0296 – Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making)
  • G0297 – LDCT for lung cancer screening

ICD-10 Codes

  • F17.210, F17.211, F17.213, F17.218, F17.219, Z87.891
    • These are suggested codes, but not an all-inclusive list.

Helpful Resources

Tobacco HelpLine Referral Instructions and Patient Talking Points

EPIC Providers

  • Maine Tobacco HelpLine: Referrals can be made directly from the Best Practice Advisory pop-up window that displays after entering tobacco use status.
  • QuitWorks - New Hampshire: EPIC does not currently support direct referrals. Provider must document in EPIC that counseling was given and then use QuitWork’s online referral process.

Non-EPIC Providers

  • Maine Tobacco HelpLine: For non-EPIC practices that have not built a referral to the HelpLine in your EMR system, use the fax referral form. A prepopulated fax referral form is highly recommended and can be made available to practices. For more information, contact: Linda Craig, Maine Tobacco HelpLine Program Coordinator at:
  • QuitWorks - New Hampshire: Provider must document in EMR that counseling was given and then use QuitWork’s online referral process.

For non-EPIC practices that have not built a referral to the HelpLine in your EMR system, use the fax referral form. A prepopulated fax referral form is highly recommended and can be made available to practices. For more information, contact:

For non-EPIC practices that have not built a referral to the HelpLine in your EMR system, use the fax referral form. A prepopulated fax referral form is highly recommended and can be made available to practices. For more information, contact:

For non-EPIC practices that have not built a referral to the HelpLine in your EMR system, use the fax referral form. A prepopulated fax referral form is highly recommended and can be made available to practices. For more information, contact:

For non-EPIC practices that have not built a referral to the HelpLine in your EMR system, use the fax referral form. A prepopulated fax referral form is highly recommended and can be made available to practices. For more information, contact:

Starting the conversation:

“Tell me your thoughts about quitting.” Provider listens attentively and demonstrates respect and compassion for the patient experience.

“I care about you and quitting smoking is the most important thing that you can do for your health right now. We would like to connect all of our patients who use tobacco to (Maine Tobacco Helpline or QuitWorks-New Hampshire) to talk about treatment options. I’d like to send a referral through and they will call you in 1-2 days.”

If they say no:

“Okay, I understand that it’s hard to quit. I want you to know that we are here when you are ready. Here is some information about (Maine Tobacco Helpline or QuitWorks-New Hampshire) if you change your mind later.

Patient Education Resources

The MaineHealth Lung Screening Task Force has developed patient outreach and education materials to support lung cancer screening. Click here to view and order these materials for use in your practice.