CPT 71271Radiology

Ct thorax lung cancer scr c-

CPT code 71271 covers a low-dose CT scan of the chest used specifically to screen for lung cancer in high-risk patients, such as current or former heavy smokers. This preventive imaging helps detect lung cancer early when it's most treatable.

Showing rates for

National Average

Base Medicare rate

$135.53

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.08

PE RVU (NF)

3.04

MP RVU

0.07

Total RVU

4.19

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify annual frequency limits before scheduling - Medicare covers 71271 only once per 12-month period
Impact: Prevents automatic denials that delay payment by 30-60 days and require resubmission
Document the qualifying shared decision-making visit (G0296) separately and prior to the screening CT
Impact: G0296 counseling visit is required annually and pays approximately $24; missing this documentation is the #1 denial reason
Confirm patient meets all eligibility criteria: age 50-80, 20+ pack-year history, current smoker or quit within 15 years, asymptomatic
Impact: Ineligible patients result in 100% denial ($135.53 loss) and potential patient liability issues
Use diagnosis code Z12.2 (encounter for screening for malignant neoplasm of respiratory organs) as primary diagnosis
Impact: Using symptom codes instead of screening code converts to diagnostic CT pricing and triggers prior authorization requirements
Ensure facility has current ACR Lung Cancer Screening Center designation and include registry participation documentation
Impact: Non-accredited facilities receive automatic denials; accreditation status must be current on date of service
Bill globally (no modifier) when facility owns equipment and provides interpretation, split only when components are separate entities
Impact: Incorrect modifier usage can reduce reimbursement by 40-60% or trigger bundling edits

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 71271 in 2025?

The 2025 Medicare national average reimbursement for CPT 71271 is $135.53 for both facility and non-facility settings. This is based on 4.19 total RVUs (1.08 work RVU, 3.04 PE RVU, 0.07 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How often can CPT 71271 lung cancer screening be billed for the same patient?

CPT 71271 can be billed once every 12 months per Medicare guidelines. The 12-month period is calculated from the date of the previous lung cancer screening CT, not on a calendar-year basis. Billing more frequently typically results in denial unless the subsequent scan is diagnostic rather than screening.

What are the patient eligibility requirements for billing 71271?

Patients must be age 50-80 years, have a minimum 20 pack-year smoking history, currently smoke or quit within the past 15 years, be asymptomatic for lung cancer, and have received counseling via a shared decision-making visit. All criteria must be met and documented for Medicare coverage.

Is a counseling visit required before billing CPT 71271?

Yes, Medicare requires a documented counseling and shared decision-making visit (CPT G0296) prior to the first lung cancer screening CT and annually thereafter. This visit must include discussion of benefits, limitations, risks, and smoking cessation resources. Missing this documentation is the most common denial reason.

What diagnosis code should be used with CPT 71271?

The primary diagnosis code for CPT 71271 should be Z12.2 (encounter for screening for malignant neoplasm of respiratory organs). Using symptom codes or other diagnostic codes instead will cause the claim to be processed as diagnostic rather than screening, potentially triggering denials or prior authorization requirements.

Does CPT 71271 require prior authorization from Medicare?

Traditional Medicare does not require prior authorization for CPT 71271 when medical necessity criteria are met. However, Medicare Advantage plans may have different requirements, and some commercial payers do require authorization. Always verify payer-specific requirements before scheduling.

What is the difference between CPT 71271 and 71250 for chest CT?

CPT 71271 is specifically for lung cancer screening in asymptomatic high-risk patients using low-dose protocols and has specific eligibility criteria. CPT 71250 is a diagnostic chest CT without contrast used for patients with symptoms or findings requiring evaluation. The intent (screening vs. diagnostic) and patient presentation determine the correct code.