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HCPCS G0296 · Level II · G code

G0296: Visit to determ LDCT elig, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0296

Medicare payment
$28.72
PFS non-facility, national; facility $22.38
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
1
1 hospital outpatient
LCDs and articles
0 / 1
on the Medicare telehealth list

TL;DR

G0296 is a Level II code from the G section (procedures and professional services, temporary), in use since 2015: "Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)". Under the 2026 physician fee schedule (October release) G0296 carries 0.52 work, 0.31 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $28.72 non-facility and $22.38 facility before the locality adjustment. Qualifying APM participants get $28.87 at $33.5675. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). G0296 is a primary code for 1 add-on code (G0513). In the NCCI PTP files v323r0 G0296 appears in 1 practitioner pairs as column 2 and 0 as column 1 (most often with 99452), and in 1 hospital outpatient pairs as column 2 and 0 as column 1. 1 billing and coding article lists G0296 across 4 states: A58641. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). HCPCS record: BETOS M6 (consultations); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0289, G0283, G0282, G0281.

G0296 descriptor and code status

The October 2026 HCPCS Level II file describes G0296 as “Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0296 CPT code", G0296 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0296
FieldValue
Short descriptorVisit to determ ldct elig
Added to HCPCS2015-02-05
Last actionN (no maintenance), effective 2015-02-05
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM6: consultations
Type of service1: medical care

Medicare payment for G0296

Under the 2026 physician fee schedule (October release) G0296 carries 0.52 work, 0.31 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $28.72 non-facility and $22.38 facility before the locality adjustment. Qualifying APM participants get $28.87 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0296
ComponentNon-facilityFacility
Work RVU0.520.52
Practice expense RVU0.310.12
Malpractice RVU0.030.03
Total RVUs0.860.67
National payment (CF $33.4009)$28.72$22.38
Qualifying APM participant (CF $33.5675)$28.87$22.49
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator S (Procedure or service, not discounted when multiple), APC 5822 (Level 2 Health and Behavior Services), national unadjusted payment $103.79 with a minimum unadjusted copayment of $0.00.

Medically Unlikely Edits for G0296

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0296 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0296 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0296 is the column-2 (bundled) code in 1 active pair, 0% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0296 (practitioner)
Column-1 codePairs
99452 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0296 is the column-2 (bundled) code in 1 active pair, 0% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0296 (hospital outpatient)
Column-1 codePairs
99452 (CPT; descriptor licensed by AMA)1

G0296 is a designated primary code for 1 add-on code (G0513).

Pair counts show exposure, not the answer for one claim. Check G0296 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0296

0 active Local Coverage Determinations and 1 billing and coding article list G0296. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0296
ArticleTitleContractor(s)Related LCD
A58641Billing and Coding: IDTFs and Low Dose CT Scan for Lung Cancer Screening for CPT Code 71271Palmetto GBA—

Telehealth status

G0296 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G0296

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0296

CARC 151 · N362

units of G0296 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0296 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0296 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0296

What does HCPCS code G0296 describe?

"Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)" (short descriptor "Visit to determ ldct elig"), in the G section (procedures and professional services, temporary). Added 2015-02-05.

Is G0296 a CPT code?

No. G0296 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0296 CPT code" mean this Level II code.

What does Medicare pay for G0296?

Under the 2026 physician fee schedule (October release) G0296 carries 0.52 work, 0.31 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $28.72 non-facility and $22.38 facility before the locality adjustment. Qualifying APM participants get $28.87 at $33.5675.

Is G0296 an add-on code?

G0296 is a primary code for 1 add-on code (G0513).

How many units of G0296 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0296?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 billing and coding article lists G0296 across 4 states: A58641.

Can G0296 be billed as telehealth?

Yes. G0296 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.