Does Medicare Cover Lung CT (LDCT) Screening? (2026)

Direct Answer: Yes, With Four Specific Eligibility Criteria

Yes. Original Medicare Part B covers annual LDCT lung cancer screening at no cost when you meet all four criteria: (1) age 50 to 77, (2) at least 20 pack-years of tobacco smoking history, (3) currently smoke or quit smoking within the last 15 years, and (4) show no signs or symptoms of lung cancer at the time of the order.

What Original Medicare Covers for Lung Cancer Screening

Original Medicare Part B covers two separate services under the lung cancer screening benefit. The first is the counseling and shared decision-making visit (billed with CPT code G0296), required before your first LDCT scan. During this visit, your provider discusses your risk factors, the benefits and harms of screening, the importance of annual follow-through, and, if you smoke, options for cessation. Starting with your second annual screening, the G0296 counseling visit is no longer required but may still be billed if your provider chooses to document it.

The second service is the annual LDCT scan itself, billed with CPT code 71271. Both services are covered under Medicare Part B as preventive benefits with $0 patient cost-sharing when the provider accepts assignment and you meet all four eligibility criteria. Medicare Part B covers one LDCT screening per year. A second scan in the same calendar year is not covered as a preventive service. The facility must use a standardized lung nodule identification and reporting system (such as Lung-RADS), and the reading radiologist must hold board certification or board eligibility with the American Board of Radiology or an equivalent organization.

The Four Eligibility Criteria in Detail

Medicare's 2026 lung cancer screening eligibility requirements, set by CMS NCD 210.14 (updated February 2022), require all four of the following. First, age: you must be between 50 and 77 years old. The USPSTF 2021 recommendation goes up to age 80, but Medicare's NCD caps coverage at 77. If you are 78 to 80 and meet the other criteria, coverage under Original Medicare is not available for the screening even though your doctor may recommend it based on USPSTF guidance. Second, smoking history: you must have smoked at least 20 pack-years. One pack-year equals smoking one pack (20 cigarettes) per day for one year. Twenty pack-years can be reached by smoking one pack a day for 20 years, or two packs a day for 10 years, or other equivalent combinations.

Third, smoking status: you must currently smoke or have quit within the last 15 years. Former smokers who quit more than 15 years ago no longer qualify for the Medicare-covered annual screening under current NCD rules. Fourth, asymptomatic: you must have no signs or symptoms of lung cancer. If you already have symptoms such as hemoptysis (coughing up blood), unexplained weight loss, new onset of cough, or chest pain that your physician attributes to possible lung cancer, any CT ordered is diagnostic rather than screening, and standard Part B cost-sharing applies. In that situation, you have met your 2026 Part B deductible of $283 and then pay 20% coinsurance.

What Medicare Advantage May Add (2026)

Medicare Advantage plans (Part C) are required by CMS to cover every service that Original Medicare covers, including the annual LDCT lung cancer screening and the G0296 counseling visit, without applying cost-sharing when you use an in-network provider and meet the four eligibility criteria. Some Medicare Advantage plans go further and cover LDCT for enrollees who meet the USPSTF criteria (ages 50 to 80) rather than stopping at the Medicare NCD age limit of 77, though this varies by plan. Check your plan's Evidence of Coverage document or call member services to confirm the exact age limit and any prior authorization requirements your plan imposes.

One important Medicare Advantage consideration is network. Original Medicare allows you to go to any Medicare-accepting facility nationwide for the screening. Medicare Advantage plans require you to use in-network facilities to get the $0 cost. If you go out of network at a Medicare Advantage plan without a Point-of-Service option, you may owe the full cost of the scan, which ranges from $100 to $500 at independent imaging centers in 2026 or $600 to $1,200 at hospital outpatient departments.

Cost Without Coverage in 2026

Without any insurance coverage, an LDCT lung cancer screening typically costs $100 to $500 at independent imaging centers in 2026, based on FAIR Health and MDsave data. Hospital outpatient departments charge more, typically $600 to $1,200 for the same scan. The national average Medicare reimbursement rate for CPT 71271 is approximately $173 to $232 in 2026, depending on geographic location and facility type. Several advocacy programs and hospital community benefit programs offer reduced-cost or free LDCT screenings for uninsured high-risk patients, including programs affiliated with the American Lung Association's Saved by the Scan initiative and GO2 Foundation for Lung Cancer resources.

The Counseling Visit and How to Find a Participating Facility

Before your first Medicare-covered LDCT, your ordering physician, nurse practitioner, physician assistant, or clinical nurse specialist must complete a counseling and shared decision-making visit documented in your medical record. The 2022 CMS update simplified these documentation requirements and allows auxiliary personnel to provide the counseling incident to a physician's professional service, which has expanded access to the benefit in busy primary care settings. The counseling visit covers your personal lung cancer risk, the potential benefits and harms of annual screening, what happens if the scan finds a nodule, and smoking cessation resources if you still smoke.

To find a Medicare-certified lung cancer screening facility, use the CMS Lung Cancer Screening Registry finder at cms.gov or ask your primary care provider for a referral to an ACR-accredited lung cancer screening program. The American College of Radiology maintains a registry of accredited centers. Once you have a referral order, call the imaging center to confirm they accept your Medicare or Medicare Advantage plan before your appointment to avoid surprise costs from out-of-network billing.

Screening vs. Diagnostic CT: Why the Distinction Matters for Your Bill

Medicare covers the annual LDCT as a preventive screening at $0 cost-sharing. If that screening finds a suspicious nodule, your physician will likely order additional imaging, such as a follow-up low-dose CT in three to six months or a higher-resolution CT or PET scan. Those subsequent scans are diagnostic, not preventive, and standard Part B rules apply. In 2026, that means you pay the $283 annual Part B deductible if you have not already met it, plus 20% coinsurance of the Medicare-approved amount after the deductible. At a typical Medicare-approved rate of $173 to $232 for CPT 71271, a diagnostic follow-up CT could cost you approximately $35 to $50 in coinsurance after your deductible is met.

Medigap plans that include Part B coinsurance coverage (plans C, D, F, G, K, L, M, and N) will cover most or all of that diagnostic follow-up coinsurance. Medicare Advantage plans handle follow-up imaging per their own cost-sharing schedule, which varies by plan. Requesting an itemized bill from the imaging center after any CT scan is advisable to confirm whether the scan was billed as preventive (G0296 or CPT 71271 with QLP modifier indicating screening) or diagnostic.

Alternatives When Medicare Does Not Cover the Screening

Medicare does not cover LDCT screening if you are outside the 50 to 77 age window, quit smoking more than 15 years ago, have fewer than 20 pack-years of smoking history, or have symptoms that make the CT diagnostic rather than preventive. Several alternatives exist. ACA-compliant private insurance plans must cover LDCT screening at no cost-sharing for individuals who meet the USPSTF criteria (ages 50 to 80) because it holds a USPSTF Grade B recommendation. Starting January 1, 2026, the ACA subsidy cliff has returned, meaning marketplace plan premiums are more expensive for higher-income individuals than they were during the enhanced subsidy period that ended December 31, 2025. For people under 65, a marketplace plan remains the most reliable path to free LDCT screening.

Medicaid in expansion states (40 states plus DC) must cover LDCT lung cancer screening at no cost under the ACA preventive services mandate because the USPSTF gave LDCT a Grade B recommendation. Lung cancer screening is an essential health benefit for ACA-compliant Medicaid expansion plans, meaning no preexisting condition exclusion can block access. Non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming) are not required to cover LDCT under Medicaid for their adult expansion population, because they have not adopted expansion. Community health centers and hospital-affiliated lung cancer screening programs frequently offer free or reduced-cost scans; the GO2 Foundation for Lung Cancer and the American Lung Association both maintain directories of such programs. Veterans who meet the eligibility criteria can receive LDCT at no cost through VA health care. Note that Medicare Part A does not cover the outpatient LDCT screening; it is solely a Medicare Part B preventive benefit, and Medicare Part D does not apply because LDCT is a procedure, not a prescription drug.

How to Get Your Medicare LDCT Lung Cancer Screening

Medicare covers LDCT lung cancer screening year-round; there is no annual enrollment window. To start the process, bring up your smoking history at your next primary care visit or schedule a dedicated visit to discuss lung cancer screening eligibility. Your provider will document the counseling and shared decision-making discussion and, if you are eligible, order the LDCT scan. Medicare does not require a referral from a specialist, only a written order from your treating physician, nurse practitioner, physician assistant, or clinical nurse specialist.

• Step 1: Confirm eligibility. Review the four criteria (age 50-77, 20+ pack-years, current smoker or quit within 15 years, no lung cancer symptoms) with your provider.
• Step 2: Complete the counseling visit (G0296). Your ordering provider documents the shared decision-making discussion in your medical record before issuing the screening order.
• Step 3: Get a written order. Your provider issues a written order for low-dose CT lung cancer screening (CPT 71271) citing your eligibility.
• Step 4: Find an ACR-accredited LDCT center. Use the CMS registry at cms.gov/medicare/coverage/approved-facilities-trials-registries/lunch-cancer-screening or ask your provider for a referral. Call ahead to confirm they accept your specific Medicare or Medicare Advantage plan.
• Step 5: Attend the appointment. Bring your Medicare card or Medicare Advantage plan ID. Confirm with the scheduler that the scan is being billed as a preventive screening (not diagnostic).
• Step 6: Review the Lung-RADS result with your provider. Results use the Lung-RADS 1-4 scale. Low-category results (1 or 2) mean continue annual screening; higher categories (3 or 4) trigger additional workup that may involve diagnostic imaging with standard cost-sharing.

Does Original Medicare cover lung cancer CT screening?

Yes. Original Medicare Part B covers annual LDCT lung cancer screening (CPT 71271) at $0 cost when you meet all four eligibility criteria: age 50-77, at least 20 pack-years of smoking history, currently smoke or quit within the past 15 years, and have no signs or symptoms of lung cancer. Your provider must also complete a covered counseling visit (G0296) before your first scan.

How often does Medicare cover a lung cancer CT scan?

Medicare covers one LDCT lung cancer screening per calendar year at $0 cost-sharing for eligible beneficiaries. A second scan in the same year is not covered as a preventive benefit. If you had an abnormal result and need a follow-up scan within the year, that follow-up is billed as diagnostic imaging under standard Part B rules: the 2026 Part B deductible is $283, then 20% coinsurance.

What is the 20 pack-year requirement for Medicare lung screening?

Twenty pack-years means smoking one pack of cigarettes (20 cigarettes) per day for 20 years, or the equivalent. Two packs per day for 10 years also equals 20 pack-years, as does half a pack a day for 40 years. You calculate pack-years by multiplying packs smoked per day by the number of years smoked. CMS updated the requirement from 30 pack-years to 20 pack-years in February 2022, expanding Medicare coverage to more beneficiaries.

Does Medicare cover lung cancer screening for former smokers?

Yes, but only if you quit within the past 15 years. Former smokers who quit more than 15 years ago no longer qualify for the Medicare-covered LDCT screening under the current National Coverage Determination. If you quit exactly 15 years ago you still qualify; once you cross that threshold you are no longer eligible for the $0 preventive screening under Original Medicare.

What does Medicare cover if the LDCT scan finds a nodule?

If the annual LDCT screening finds a lung nodule, your provider will classify it using the Lung-RADS scale. Categories 1 and 2 (probably benign) lead to continued annual screening at $0. Categories 3 and 4 trigger additional diagnostic workup, which may include a follow-up CT in 3-6 months, a PET scan, or a biopsy. Those additional tests are billed as diagnostic services, not preventive, and your standard 2026 Part B cost-sharing applies (the $283 deductible, then 20% coinsurance).

Does Medicare Advantage cover LDCT lung cancer screening?

Yes. Medicare Advantage plans must cover everything Original Medicare covers, including annual LDCT lung cancer screening at $0 cost for in-network providers when you meet the eligibility criteria. Some Medicare Advantage plans voluntarily extend coverage to ages 50-80 (matching USPSTF guidance) rather than stopping at 77. Out-of-network screening at a Medicare Advantage plan may result in full cost, typically $100-$500 at independent imaging centers in 2026.

How do I find a Medicare-certified lung cancer screening facility?

Use the CMS Lung Cancer Screening Registry finder at cms.gov to locate facilities that submit data to the national registry (a Medicare requirement). You can also ask your primary care provider for a referral to an ACR-accredited lung cancer screening program. Call the facility before your appointment to confirm they accept your Medicare or Medicare Advantage plan and will bill the scan as a preventive screening.

Does Medicaid cover LDCT lung cancer screening?

Medicaid in the 40 expansion states plus DC must cover LDCT lung cancer screening at no cost because it holds a USPSTF Grade B recommendation and the ACA requires expansion-state Medicaid to cover such services without cost-sharing. In the 10 non-expansion states (AL, FL, GA, KS, MS, SC, TN, TX, WI, WY), Medicaid is not required to cover the screening for the adult expansion population, though individual state programs may choose to do so. Contact your state Medicaid office to confirm coverage in non-expansion states.