Lung Cancer Screening — CPB 0380 | AETNA Coverage Update

Aetna modified CPB 0380 for lung cancer screening using low-dose CT, effective September 26, 2025. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its lung cancer screening coverage policy under CPB 0380 to include a second covered indication: post-treatment surveillance LDCT for non-small cell lung cancer (NSCLC) survivors. The primary covered code remains CPT 71271 — computed tomography, thorax, low dose for lung cancer screening, without contrast. If your practice bills lung cancer screening or treats NSCLC survivors, this change adds a new reimbursement pathway you need to build into your workflows before claims start dropping.

Quick-Reference Table

Aetna Lung Cancer Screening Coverage Criteria and Medical Necessity Requirements 2025

The Aetna lung cancer screening coverage policy under CPB 0380 covers annual LDCT on two separate tracks. Each has distinct medical necessity criteria. Billing the wrong indication against the wrong patient profile is the fastest way to generate a claim denial.

Track 1 — High-Risk Screening. Aetna considers annual LDCT medically necessary for current or former smokers who meet all three of these criteria:

Bill CPT 71271 for the LDCT itself. Bill HCPCS G0296 for the required counseling visit to discuss the need for LDCT screening. G0296 is covered when selection criteria are met — it's not optional documentation, it's a billable service.

Track 2 — Post-Treatment Surveillance (New). Aetna now considers annual LDCT medically necessary for NSCLC survivors undergoing surveillance. The clock starts two years after definitive treatment. This applies to patients with non-small cell lung cancer across ICD-10-CM codes C34.0 through C34.9 and their subcategories.

This second track is the meaningful addition in the September 26, 2025 update. Before this change, the policy focused on high-risk screening for healthy patients. Now it explicitly covers a different population — treated cancer survivors — under the same CPT 71271 code but with different ICD-10 coding and documentation requirements.

The real issue here is diagnosis code selection. A 58-year-old former smoker getting annual screening bills very differently than a 58-year-old NSCLC survivor two years out from surgery. Both use CPT 71271, but your ICD-10 code, your medical necessity documentation, and potentially your prior authorization path are different. Conflating the two populations in your charge capture will generate denials.

Aetna's lung cancer screening billing guidelines do not explicitly list prior authorization requirements in the CPB 0380 policy language — but prior auth requirements vary by plan. Check individual plan benefits before billing, especially for the surveillance indication, which is newer and more likely to trigger payer scrutiny.

Coverage Indications at a Glance

Aetna Lung Cancer Screening Exclusions and Non-Covered Indications

The CPB 0380 policy does not use the word "experimental" broadly, but several patterns in the code groupings signal what Aetna will not pay for under this policy.

CPT codes 0174T and 0175T — computer-aided detection (CAD) using AI algorithms on CT images — are grouped as "artificial intelligence-based imaging — no specific code." That grouping label is Aetna's way of saying: no distinct coverage determination exists. Do not assume these are covered just because they appear in the policy. They appear as related codes, not covered codes. Bill them separately only if you have confirmed plan-level coverage.

PET imaging codes 78811 through 78816 also appear in the AI/imaging group, not in the covered code group. PET is not the covered screening modality here. CPT 71271 is. If a patient needs PET for workup after an abnormal LDCT, that's a different clinical scenario with different billing rules.

Chest X-ray codes 71045, 71046, 71047, and 71048 are listed as "other CPT codes related to the CPB" — not covered for lung cancer screening. Chest radiography does not satisfy screening criteria under this policy.

The age and smoking history thresholds are hard limits for Track 1. A 49-year-old with a 25 pack-year history does not qualify. A 55-year-old with a 15 pack-year history does not qualify. Neither will pass a medical necessity review.

Aetna Lung Cancer Screening Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Lung Cancer Screening Under CPB 0380

Covered CPT and HCPCS Codes (When Selection Criteria Are Met)

AI-Based Imaging — No Specific Coverage Designation

Key ICD-10-CM Diagnosis Codes (NSCLC — Post-Treatment Surveillance Indication)

The full ICD-10-CM list in CPB 0380 runs to 138 codes across the C34.x family. Use the most specific laterality and encounter code available in the patient's record. "Unspecified side" codes will draw scrutiny on a cancer surveillance claim — your documentation will have a side.