Why Did My Lung Cancer Screening Get Billed?
An annual low-dose CT lung cancer screening is free on most plans, if you meet the eligibility criteria and it is coded as a screening. A bill usually means you fell outside the criteria, the scan was diagnostic, or it was coded as a regular chest CT. Here is how to tell.
Should your lung CT have been free?
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Why was the CT scan done?
The short answer
On most insurance (non-grandfathered ACA plans), an annual low-dose CT (LDCT) lung cancer screening is covered with no cost-sharing, but only if you meet the eligibility criteria and it is billed as a screening. Two things most often cause a bill: you fell outside the criteria, or the scan was coded as a diagnostic chest CT instead of a screening LDCT (code G0297).
A required counseling (shared decision-making) visit before the scan is also covered. The deciding move is to read the codes on your Explanation of Benefits.
Who qualifies for the free screening
The no-cost screening applies to people who meet all of these. If any one does not fit, the scan may not be the covered $0 screening.
- Roughly 50 to 80 years old.
- A 20 pack-year smoking history (for example, one pack a day for 20 years, or two packs a day for 10).
- Currently smoke, or quit within the past 15 years.
- A required shared decision-making counseling visit first (also covered).
The parts of a lung CT bill to check
- The screening code (G0297) versus a regular diagnostic chest CT code, the biggest driver of whether you owe.
- Your eligibility on the date of service (age, pack-years, quit time).
- Whether it was screening or a nodule/symptom follow-up (the latter is diagnostic).
- The facility fee (hospital outpatient vs freestanding imaging center).
- The radiologist reading fee, sometimes an out-of-network provider you did not choose.
What to do if you get a bill
- Compare the bill against your EOB, and look for code G0297 (screening LDCT) versus a diagnostic chest CT code. Our denial-code decoder helps.
- Confirm you met the eligibility criteria on the date of the scan, if so and it was truly screening, the coding may be wrong.
- Ask the imaging center to review and correct the coding if it was billed as a diagnostic CT by mistake.
- If it should have been free and was not, appeal it, you generally have 180 days.
Have us check the bill
Send us the bill and the EOB. CareRoute Bill Defense checks whether an eligible screening scan was miscoded as a diagnostic chest CT, whether a facility or out-of-network charge is proper, and whether a diagnostic scan was billed correctly, then disputes what should not have been billed and negotiates the rest.
Send us the billFree to submit. You only pay if we save you money.
Frequently asked questions
Is a lung cancer screening supposed to be free?
For people who meet the eligibility criteria, yes. Non-grandfathered ACA plans must cover an annual low-dose CT (LDCT) lung cancer screening with no cost-sharing for adults who are roughly 50 to 80 years old, have a 20 pack-year smoking history, and currently smoke or quit within the past 15 years. A required shared decision-making (counseling) visit before the scan is also covered. Grandfathered and non-ACA plans are exempt.
Why did I get a bill for my lung CT scan?
Common reasons: you did not meet the eligibility criteria, so it was not the covered $0 screening; the scan was diagnostic (to evaluate symptoms or follow up a nodule); it was coded as a regular diagnostic chest CT instead of a screening LDCT (code G0297); a facility fee was added; or an out-of-network provider or radiology group was involved.
I don’t meet the screening criteria. Do I owe?
If you are outside the age, pack-year, or quit-time criteria, the scan is not the covered preventive screening, so cost-sharing can apply. But if a doctor ordered the CT for a medical reason, it may be covered as diagnostic (with cost-sharing) rather than denied outright. Either way, the bill is negotiable, and it is worth checking the coding and network status.
My scan was to follow up a nodule. Is that screening?
No. Following up a known nodule or a prior finding is diagnostic surveillance, not screening, so cost-sharing generally applies. That is usually not a billing error. But check the bill for coding mistakes, a facility fee, or an out-of-network reading, all of which can be challenged or reduced.
What is code G0297?
G0297 is the billing code for a screening low-dose CT for lung cancer. If you were eligible and it was truly a screening scan but it was coded as a regular diagnostic chest CT instead, that mismatch can be why cost-sharing was applied, and the coding may be worth correcting or appealing.
Does Medicare cover lung cancer screening?
Yes. Medicare covers an annual screening LDCT at no cost for eligible people (roughly ages 50 to 77 with a similar smoking history), after a required counseling and shared decision-making visit. If you expected a free screening and got a bill, an eligibility or coding issue is often why.
Can CareRoute help with a lung screening bill?
Yes. CareRoute Bill Defense reads your bill and Explanation of Benefits, checks whether an eligible screening scan was miscoded as a diagnostic chest CT, whether a facility or out-of-network charge is proper, and whether a diagnostic scan was billed correctly, then disputes what should not have been billed and negotiates the rest. It is free to submit, and you only pay if we save you money.
Related
Sources & references
This is general information, not legal, medical, or insurance advice, and does not create a client relationship. The no-cost screening depends on your plan type (grandfathered and some non-ACA plans are exempt) and on meeting the eligibility criteria, and a diagnostic or nodule-follow-up scan can be billed with cost-sharing. Medicare criteria differ. Check your plan documents and your EOB. Last updated: August 2026.