Are there any special billing guidelines when a CPT code description includes the terms “screen” or “screening”?
According to the Centers for Medicare & Medicaid Services (CMS), the use of these terms in CPT code descriptors does not necessarily describe a test performed in the absence of signs and symptoms of illness, disease or condition. Contractors do not deny a service based solely on the presence of them.
Tests that are performed in the absence of signs, symptoms, complaints, personal history of disease, or injury are not covered except when there is a statutory provision that explicitly covers tests for screening as described.
If a person is tested to rule out or to confirm a suspected diagnosis because the patient has a sign and/or symptoms, this is considered a diagnostic test, not a screening test. Contractors have discretionary authority to make reasonable and necessary scope of benefit determinations, CMS states.