For Dates of Service Before January 1, 2021

Low-Dose Computed Tomography Scans

ForwardHealth covers low-dose CT scans (identified by HCPCS procedure code G0297) for lung cancer screening without PA for Wisconsin Medicaid and BadgerCare Plus-enrolled members who are at high risk for lung cancer and meet all of the following criteria:

• Are aged 55 to 80
• Have a 30-pack-a-year smoking history, as indicated by the appropriate ICD diagnosis code
• Are either current smokers or have quit smoking within the past 15 years, as indicated by the appropriate ICD diagnosis code
• Have no signs or symptoms suggestive of underlying cancer

ForwardHealth requires PA for coverage of all other CT scans, including those that would be performed as a follow up to the initial low-dose CT screening, unless the provider has an exemption under ForwardHealth's advanced imaging PA exemption program.