e-Referral - News Item

Preventive lung cancer screening requires clinical review effective Oct. 1, 2015

Effective Oct. 1, 2015, preventive screening for lung cancer using low-dose computed tomography requires clinical review. For this preventive service, members do not have cost-sharing responsibilities. This is because under the Patient Protection and Affordable Care Act and Medicare's National Coverage Determination process, insurers must cover preventive services with no member cost-sharing.

Here is some important additional information you'll need to know:

For BCN HMO^SM (commercial) patients, submit both the request for clinical review and the claim using HCPCS procedure code S8032.

For BCN Advantage^SM patients, use procedure code S8032 temporarily to submit the request for clinical review. As for claims, the Centers for Medicare & Medicaid Services has not yet published the HCPCS code that will be used for Medicare members receiving this service. For now, CMS has advised providers to hold claims until the code is made available. However, submitting the request for clinical review is required even though the billing guidelines are not yet available.

Use *71250 for non-preventive services. For both BCN HMO and BCN Advantage patients, clinical review requests and claims involving non-preventive screening for lung cancer with low-dose computed tomography services should continue to be submitted using procedure code *71250. When you use this code, the member will have cost-sharing responsibilities.

Submit requests to eviCore. All requests for clinical review should be submitted to eviCore healthcare (formerly CareCore National) in one of the following ways:

Preferred method: online at www.evicore.com
By phone at 1-855-774-1317

The requests should be submitted prior to services being provided.

Additional information. Look for additional information in the September-October 2015 issue of BCN Provider News, in the Referral Roundup section. This issue will be published at the end of August.