Effective Sept. 1, 2021: Lung Cancer Screening Benefits Changes - Texas Medicaid
What is New?
Per the Texas Medicaid and Healthcare Partnership (TMHP) , effective for dates of service on or after Sept. 1, 2021, lung cancer screening benefits will change for Texas Medicaid.
Major changes to this medical benefit include:
- Expanded benefit information
- Addition of prior authorization guidelines
- Identification of excluded services
Requirements for Billing
- Procedure Code: 71271: Preventive lung cancer screening- low dose computed tomography (LDCT)
- Benefit: Once per year for asymptomatic high-risk clients meeting screening criteria
- Referrals from: Physician, physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) can order radiological procedures, which are appropriate for their licensure.
Contact our BCBSTX Medicaid Provider Service Center at 1-877-560-8055 or contact your BCBSTX Medicaid Provider Network Representative at 1-855-212-1615.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.