A fixed cost you need to pay for certain medical services, usually at the time of service. Office visits and prescription medicine often require copays. Example: A visit to the family doctor may require a $25 copay, while an emergency room visit may involve a larger copay. Pharmacy prescriptions often have a copay.

  1. Humana Copay For Ct Scan
  2. Copay Assistance For Ct Scan
  3. Bcbs Copay For Ct Scan
  4. How Much Is Copay For Ct Scan

** SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. © Tivity Health, Inc. All rights reserved.

  • Compared with conventional CT scans, these scans allow for the continuous acquisition of images, thus shortening the scan time and radiation exposure. A complete spiral or ultrafast CT scan can be obtained within 10-20 seconds, or during one breath hold for the majority of individuals.
  • CT scans, MRIs, PET scans, genetic testing, nuclear medicine and sleep studies in an. Tier 1 (Generics): $15 copay Tier 2 (Preferred brand): $80 copay.
Scan

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*** Glucometer and test strip brands include Ascensia (CONTOUR™NEXT & PLUS) and LifeScan (OneTouch®).

This information is not a complete description of benefits. Call 1-855-828-3982 (TTY 711)* for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider networ may change at any time. You will receive notice when necessary. To the extent of any discrepancy between this web site and your Evidence of Coverage/Contract Booklet, your Evidence of Coverage/Contract Booklet takes priority.

BlueCross BlueShield of Tennessee Medical Policy Manual

Computed Tomography (CT) Scanning for Lung Cancer Screening

DESCRIPTION

Low-dose computed tomography (LDCT) is a radiographic technique that provides high-quality, three-dimensional images of the lungs with less radiation exposure than conventional high-resolution CT scanning. This imaging technique has been proposed for screening asymptomatic, high-risk individuals for early lung cancer lesions.

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LDCT uses either spiral (also referred to as helical) or electron beam (also referred to as ultrafast) CT scanning. Compared with conventional CT scans, these scans allow for the continuous acquisition of images, thus shortening the scan time and radiation exposure. A complete spiral or ultrafast CT scan can be obtained within 10-20 seconds, or during one breath hold for the majority of individuals. The radiation exposure for this exam is greater than that of a chest x-ray but much less than a conventional CT scan.

This policy applies to individuals with no signs or symptoms suggestive of underlying lung cancer. In symptomatic individuals, a diagnostic work-up appropriate to the clinical presentation should be undertaken.

POLICY

  • Low dose computedtomography scanning (e.g., helical, ultrafast) is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)

  • Low dose computed tomography scanning (e.g., helical, ultrafast) as a screening technique for all other indications is considered investigational.

  • Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.

MEDICAL APPROPRIATENESS

  • Ezonics webcam driver. Low dose computedtomography scanning (e.g., helical; ultrafast) is considered medically appropriate if ALL of the following criteria are met:

    • When performed as a screening technique for lung cancer on an individual considered to be a potential candidate for curative treatment

    • The individual is between55 and 80 years of age

    • The individual has no signs or symptoms suggestive of underlying lung cancer

    • The individual has at leasta 30 pack-year smoking history and ANY ONE of the following: (See additional information below for definition of a pack-year)

      • Current smoker

      • The individual stopped smoking within the past 15 years

    • Individual has not received a low-dose CT lung screening in less than 12 months

IMPORTANT REMINDERS

  • Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.

  • We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

ADDITIONAL INFORMATION

According to theU.S. Preventive Services Task Force (USPSTF), “a ‘pack year’ means that someone has smoked an average of one pack of cigarettes per day for one year. For example, a person reaches 30 pack years of smoking history by smoking one pack per day for 30 years or two packs per day for 15 years.”

SOURCES

American Association for Thoracic Surgery. (2012, July). The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. Retrieved March 21, 2017 from http://aats.org.

American Cancer Society. (2019). Lung cancer screening guidelines. Retrieved March 22, 2019 from https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/lung-cancer-screening-guidelines.html.

Copay Assistance For Ct Scan

American College of Chest Physicians. (2018, April). Screening for Lung Cancer CHEST Guideline and Expert Panel Report. Retrieved March 25, 2020 from http://www.chestnet.org.

American Society of Clinical Oncology (ASCO). (2012). The role of CT screening for lung cancer in clinical practice. Retrieved March 22, 2019 from https://www.asco.org/practice-guidelines/quality-guidelines/guidelines/thoracic-cancer#/10211.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for lung cancer screening with low dose computed tomography (LDCT). Retrieved March 22, 2019 from https://www.cms.gov.

National Comprehensive Cancer Network. (2019, May). NCCN Clinical Practice Guidelines in Oncology. (NCCN Guidelines®). Lung cancer screening (V.1.2020). Retrieved March 25, 2020 from the National Comprehensive Cancer Network.

U.S. Preventive Services Task Force. (December, 2013). Screening for lung cancer: U. S. Preventive Services Task Force recommendation statement. Retrieved March 22, 2019 from www.USPreventiveServicesTaskForce.org.

Bcbs Copay For Ct Scan

Usman, A., Miller, J., Peirson, L., Fitzpatrick-Lewis, D., Kenny, M., Sherifali, D., & Raina, P. (2016). Screening for lung cancer: a systematic review and meta-analysis. Preventive Medicine, 89, 301-314. Abstract retrieved March 22, 2019 from PubMed database.

Wang, Z., Hu, Y., Wang, Y., Han, W., Wang, L., Xue, F., et al. (2016). Can CT screening give rise to a beneficial stage shift in lung cancer patients? Systematic review and meta-analysis. PLoS One, 11 (10), e0164416: doi: 10.1371/journal.pone.0164416. (Level 1 evidence)

ORIGINAL EFFECTIVE DATE: 10/1/2003

MOST RECENT REVIEW DATE: 2/11/2021

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.