CPT® Code 71271

Quick Reference

• Code definition: CPT 71271 covers a low dose CT scan (LDCT) of the thorax performed as an annual lung cancer screening for asymptomatic, high risk individuals, without contrast material.
• Key billing rule: HCPCS G0296 (shared decision-making counseling) must be billed before or on the same date as the first-ever LDCT claim; its absence triggers automatic denial for the initial encounter [1].
• Modifier essentials: Bill globally when the radiologist owns equipment and provides interpretation; append modifier 26 for professional component only (hospital based settings); append TC for technical component only. Modifier 50 does not apply; bilateral indicator is 0 [3].
• Documentation must-have: The ordering provider's written order must document patient age 50 to 77 (Medicare), a smoking history of at least 20 pack-years, current or former smoker status (quit within 15 years), and absence of lung cancer signs or symptoms [1].
• Top confusion point: 71271 is for asymptomatic screening only. When a patient presents with symptoms such as hemoptysis or cough, the encounter is diagnostic and requires 71250, 71260, or 71270 with appropriate symptom diagnoses, not Z12.2.
• Payer alert: Medicare waives the Part B deductible and 20% coinsurance for 71271 when NCD 210.14 criteria are met. Billing 71250 for a screening encounter instead of 71271 voids the cost sharing waiver, creating unexpected patient liability and compliance exposure.
• Frequency: Annual; at least 11 months must have elapsed since the prior LDCT [1].
• Facility requirement: LDCT must be performed at an ACR accredited facility using Lung-RADS structured reporting and a mean CTDIvol of 3 mGy or less [1].

When to Use This Code

71271 applies exclusively to lung cancer screening CT of the thorax performed without contrast in asymptomatic individuals who meet all eligibility criteria. The encounter must be preventive in nature; no signs or symptoms of lung cancer may be present.

CMS NCD 210.14 eligibility criteria (revised effective February 10, 2022) [1]:

• Age 50 to 77 (Medicare; the USPSTF 2021 Grade B recommendation extends to age 80, but Medicare applies the 77 ceiling)
• Smoking history of at least 20 pack-years
• Current smoker, or former smoker who quit within the past 15 years
• Asymptomatic; no signs or symptoms of lung cancer
• Written order from a physician or qualified NPP

This code was added January 1, 2021 when CPT formally established 71271 as a distinct screening code, simultaneously revising 71250, 71260, and 71270 to include "diagnostic;" in their descriptors, explicitly separating symptom driven imaging from screening. That revision is the structural basis for treating the codes as mutually exclusive under NCCI [5].

Setting considerations: Freestanding radiology centers bill globally. Hospital based radiologists bill modifier 26 for the professional component; the hospital facility bills TC under OPPS. The Multiple Procedures indicator 4 means when multiple diagnostic imaging exams from family 88 are performed on the same day, the TC of the lower value code is reduced by 50% [3].

Code Differentiation Table

The critical differentiator is the presence or absence of symptoms. Once documentation reflects a symptom or abnormal finding warranting CT evaluation, the encounter shifts from screening to diagnostic and 71271 is no longer appropriate, regardless of the patient's eligibility status. Claims submitted with anything other than screening encounter codes (Z12.2, Z87.891, or F17.2xx) as the primary diagnosis will fail payer edits.

flowchart TD
    A[Patient presents for CT thorax] --> B{Signs or symptoms present?}
    B -- Yes --> C["Diagnostic CT: 71250 / 71260 / 71270
    Diagnosis: symptom codes
    Cost sharing applies"]
    B -- No --> D{"Meets NCD 210.14?
    Age 50-77, 20 pk-yr, asymptomatic"}
    D -- No --> E["Screening not covered
    Evaluate for diagnostic indication"]
    D -- Yes --> F{First-ever LDCT?}
    F -- Yes --> G["Bill G0296 + 71271
    Dx: Z12.2 + smoking status code
    Cost sharing waived"]
    F -- No --> H{"At least 11 months
    since prior LDCT?"}
    H -- No --> I["Frequency edit will deny
    Do not submit yet"]
    H -- Yes --> J["Bill 71271 only
    Dx: Z12.2 + smoking status code
    Cost sharing waived"]

Billing & Modifier Rules

Modifier 26 and TC split

71271 carries PC/TC Indicator 1 (Diagnostic Tests for Radiology Services), meaning the professional and technical components may be billed separately [3].

• Global (no modifier): Freestanding imaging centers or physician groups that own equipment and provide interpretation. 2026 PFS non-facility: Work 1.05, PE 2.95, MP 0.08, total 4.08 RVU.
• Modifier 26: Radiologist interpretation only. 2026 PFS: Work 1.05, PE 0.37, MP 0.06, total 1.48 RVU.
• TC modifier: Equipment, staff, and supplies. 2026 PFS: Work 0.00, PE 2.58, MP 0.02, total 2.60 RVU.

The 2026 PFS conversion factor is $33.4009 [3].

MUE and frequency

71271 has an MUE of 1 unit per date of service enforced as a CMS Policy (Date of Service Edit). No modifier overrides this limit. Annual frequency is separately enforced through claims history edits; at least 11 months must separate consecutive LDCT screening claims [4].

Add-on code 0722T

Quantitative CT tissue characterization may be reported in addition to 71271 when performed concurrently on the same imaging dataset. CPT guidelines require 0722T to be listed with 71271 as the primary procedure.

Bundling with same-day diagnostic CT

NCCI PTP edits establish mutual exclusivity between 71271 and 71250, 71260, 71270. The modifier indicator is 0, meaning no modifier override is permitted. A screening CT and diagnostic CT of the same thoracic region cannot both be medically necessary on a single date [5].

G0296 relationship

G0296 carries PC/TC Indicator 0; no 26 or TC split applies. It is a physician-only counseling service. G0296 and 71271 may be billed on the same date for the initial screening encounter. G0296 is required only for the first-ever screening; subsequent annual screenings do not require it to be rebilled [6].

Modifier 50

Does not apply. Bilateral indicator = 0 in the PFS; the thorax is a single anatomical region.

Documentation Essentials

Required elements for 71271 [1]:

• Written order from the physician or qualified NPP confirming patient age 50 to 77, pack-year history of at least 20, smoking status (current or quit within 15 years), and absence of lung cancer signs or symptoms
• Radiology report using Lung-RADS structured reporting or a CMS-recognized equivalent validated system
• CT dose documentation confirming mean CTDIvol of 3 mGy or less
• Radiologist interpretation with signature

For initial screening, additional required documentation:

• Evidence that G0296 shared decision-making counseling was performed and documented, either at a prior encounter or on the same date as the LDCT

Audit red flags specific to 71271:

• Reports lacking Lung-RADS categorization; auditors treat this as failure to meet NCD quality standards, rendering the claim non-covered
• Missing or incomplete pack-year documentation in the ordering provider's notes; a radiology report alone is insufficient to establish eligibility
• CT dose values exceeding 3 mGy CTDIvol; the scan does not qualify as low dose under NCD criteria even if billed as 71271
• Clinical indication in the ordering order referencing a symptom or incidental finding rather than screening; the indication must be asymptomatic screening, not symptom evaluation

Medicare, Commercial & Medicaid Payer Rules

Medicare

Medicare NCD 210.14 is the sole controlling coverage policy; no LCD is required and MACs cannot issue conflicting LCDs for this service [1].

The 2022 NCD revision (effective February 10, 2022) expanded eligibility from the original 2015 criteria (ages 55 to 77, at least 30 pack-years) to the current criteria (ages 50 to 77, at least 20 pack-years), aligned with the USPSTF 2021 Grade B recommendation [2]. CMS also eliminated the prior requirement that the ordering clinician have a primary care relationship with the patient.

Cost sharing waiver: As a USPSTF Grade B preventive service, Medicare waives the Part B deductible and 20% coinsurance when 71271 meets NCD criteria. This waiver is triggered by the procedure code itself; it does not apply to 71250, 71260, or 71270.

Facility requirements: CMS requires ACR accreditation (or equivalent), qualified radiologists, and a structured reporting program. A claim from a non-accredited facility is non-covered under NCD 210.14 regardless of clinical appropriateness [1].

G0297 status: HCPCS G0297 was the legacy LDCT code used from 2015 until CPT 71271 replaced it for dates of service on or after January 1, 2016. G0297 is deleted and invalid for any current claim.

OPPS: APC Status Indicator is "Procedure or Service, Not Discounted when Multiple." Facilities bill TC under OPPS; radiologists bill 71271-26 under the PFS.

Commercial Payers

Non-grandfathered commercial health plans must cover LDCT without cost sharing under ACA Section 2713 for USPSTF Grade A and B recommendations [2]. Most commercial payers follow the USPSTF 2021 criteria (ages 50 to 80, at least 20 pack-years) rather than the Medicare NCD age ceiling of 77. Commercial claims for patients aged 78 to 80 who meet other criteria may be covered where Medicare would deny. Verify prior authorization requirements before scheduling, particularly for freestanding imaging centers outside hospital networks.

Common Denials & Prevention

Missing G0296 on initial claim [1][6]

CMS requires documented shared decision-making counseling before or on the date of the first LDCT. If G0296 was never billed or is absent from the patient's claims history, the 71271 claim for a first-ever screening generates an automatic medical necessity denial.

Prevention: Verify claims history for G0296 before submitting the initial 71271 claim. If G0296 was billed separately by the ordering provider, confirm the date of service predates or matches the LDCT date.

Age or eligibility outside NCD criteria [1]

Billing 71271 for a patient under age 50 or over age 77 under Medicare, or without documented pack-year history of at least 20. The ordering provider's written order must document all eligibility elements; a referral that states "lung cancer screening" without pack-year documentation is insufficient for medical necessity review.

Prevention: Confirm eligibility at registration using NCD 210.14 criteria. Build a documentation prompt into the ordering workflow that captures age, pack-year history, and smoking cessation date.

Screening code with diagnostic diagnosis

Submitting 71271 with a symptom based ICD-10-CM code (such as R04.2 for hemoptysis) rather than Z12.2 paired with appropriate smoking history codes. CMS payer edits reject 71271 when the primary diagnosis is not a screening encounter code.

Prevention: Any documentation of symptoms in the ordering order or clinical notes converts the encounter to diagnostic; recode to 71250 with appropriate symptom codes and advise the patient that cost sharing applies.

Frequency violation

Billing 71271 before 11 months have elapsed since the last LDCT claim on record. Medicare enforces annual frequency through claims history edits beyond the MUE.

Prevention: Query claims history at scheduling. If the patient had a prior LDCT at a different facility, obtain documentation of that prior screening date before submitting a new claim.

Facility quality standard failure

LDCT performed at a non-ACR accredited facility, or a radiology report that lacks Lung-RADS categorization or CTDIvol documentation.

Prevention: Confirm ACR accreditation status before performing LDCT. Radiology report templates must include mandatory Lung-RADS category fields and CTDIvol. A claim from a non-qualifying facility is non-covered and cannot be appealed on clinical grounds; the NCD is categorical [1].

Coding Scenarios

Scenario 1: Initial screening at a freestanding imaging center

A 62-year-old current smoker with a 25 pack-year history presents to a freestanding radiology center for her first LDCT. Her primary care physician billed G0296 two weeks prior after completing the shared decision-making visit.

Correct coding: 71271 (global) with Z12.2 and F17.210

Why: G0296 was billed at the prior visit and is not required again today. The freestanding center owns equipment and provides interpretation, so no modifier split is needed. Cost sharing is waived.

Scenario 2: Hospital-based radiology, TC/26 split, subsequent annual screening

A 55-year-old former smoker (quit 8 years ago, 22 pack-years) presents to a hospital outpatient department for his third annual LDCT. The independent radiologist provides interpretation; the hospital bills the technical component separately.

Correct coding: Hospital: 71271-TC with Z12.2 and Z87.891. Radiologist: 71271-26 with Z12.2 and Z87.891.

Why: Z87.891 documents former smoker status required for NCD eligibility. G0296 is not billed for subsequent annual screenings. The TC and 26 split reflects the separate facility and professional billing relationship.

Scenario 3: Patient discloses symptoms at screening visit

A 58-year-old patient eligible for LDCT arrives for a scheduled screening. At check-in, he reports a new cough producing blood tinged sputum. The ordering physician documents the symptom. The radiologist performs CT thorax without contrast.

Correct coding: 71250 with R04.2 (hemoptysis)

Why: The symptom converts the encounter from preventive screening to diagnostic. 71271 does not apply; NCD 210.14 requires the patient to be asymptomatic. Standard Part B deductible and 20% coinsurance apply; the cost sharing waiver does not.

Scenario 4: G0296 and 71271 billed on the same day

A 71-year-old patient with no prior LDCT history presents to an office based practice that owns a CT scanner. The ordering physician performs G0296 counseling and eligibility assessment during the office visit, and the patient proceeds directly to the in-office LDCT the same day.

Correct coding: G0296 with Z12.2 and F17.210; 71271 (global) with Z12.2 and F17.210.

Why: CMS permits same-day billing of G0296 and 71271 for the initial screening encounter [6]. Both codes carry MUE of 1; one unit of each is appropriate. Both are billed with the screening diagnosis and smoking status code.

Related Codes

• 71250 (CPT): CT thorax, diagnostic, without contrast; used when symptoms or clinical findings drive the CT indication
• 71260 (CPT): CT thorax, diagnostic, with contrast; diagnostic CT requiring contrast enhancement
• 71270 (CPT): CT thorax, diagnostic, without then with contrast; diagnostic CT requiring dual phase imaging
• G0296 (HCPCS): LDCT counseling and shared decision-making visit; required before first Medicare-covered 71271
• G0297 (HCPCS): Deleted LDCT screening code; replaced by 71271 effective January 1, 2016
• 0722T (CPT): Quantitative CT tissue characterization; add-on code reportable with 71271 when performed on the same dataset
• Z12.2 (ICD-10-CM): Encounter for screening for malignant neoplasm of respiratory organs; primary diagnosis for all 71271 claims
• Z87.891 (ICD-10-CM): Personal history of nicotine dependence; secondary diagnosis for former smokers
• F17.210 (ICD-10-CM): Nicotine dependence, cigarettes, uncomplicated; secondary diagnosis for current smokers

Sources

1. CMS NCD 210.14: Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) — CMS, effective February 10, 2022 (Decision Memo CAG-00439R); governing coverage policy, eligibility criteria, G0296 requirement, and facility quality standards.
2. USPSTF Lung Cancer Screening Recommendation Statement — USPSTF, March 9, 2021; Grade B recommendation for ages 50 to 80 with at least 20 pack-years.
3. CMS Physician Fee Schedule Relative Value Files — CMS, 2026; RVU values, modifier splits, multiple procedure indicators.
4. CMS NCCI Medically Unlikely Edits (MUE) Files — CMS, effective April 1, 2026; MUE values for 71271 and G0296.
5. CMS NCCI Policy Manual, Chapter 9 (Radiology) — CMS, current edition; PTP bundling rules and mutual exclusivity of 71271 with 71250, 71260, and 71270.
6. CMS Medicare Claims Processing Manual, Chapter 18 — CMS, current; billing instructions for G0296 and 71271, same-day billing rules.