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CT lung cancer screening

Patient: CT lung cancer screening for a patient who is male, 55 years old, and has been smoking for 20 years.


CT lung cancer screening
lung

What is prior authorization requirement?


A medical claim for a CT lung cancer screening for a patient who is male 55 years old and has been smoking for 20 years would not be denied. The USPSTF recommends annual screening for lung cancer with low dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack year smoking history and currently smoke or have quit within the past 15 years. Therefore, this patient meets the criteria and a prior authorization is not needed.

Will this claim be denied?

The claim for this treatment and condition will not be denied, as the USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack year smoking history and currently smoke or have quit within the past 15 years. The patient in question meets the criteria for eligibility, so the claim should not be denied.

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