Medicare Part B covers an annual lung cancer screening with a low-dose CT scan at no cost to the beneficiary, as long as five eligibility conditions are met and the provider accepts Medicare assignment. Medicare’s lung cancer screening coverage falls under a National Coverage Determination issued by the Centers for Medicare & Medicaid Services, and it treats the scan as a preventive service, which is what removes the deductible and coinsurance.1Centers for Medicare & Medicaid Services. National Coverage Determination for Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
Who Qualifies for a Covered Screening
To have the scan covered, you must meet all five of these criteria at the time of screening:
- You are between 50 and 77 years old.
- You have no current signs or symptoms of lung cancer.
- You have at least a 20 pack-year smoking history. A pack-year is one pack a day for one year, so two packs a day for 10 years counts as 20 pack-years.
- You currently smoke, or you quit within the last 15 years.
- A physician or qualified non-physician practitioner (such as a nurse practitioner or physician assistant) has written an order for the screening.
Coverage stops the moment any one of these no longer applies. Once you turn 78, or once 16 years have passed since you quit, Medicare no longer pays for the annual scan.1Centers for Medicare & Medicaid Services. National Coverage Determination for Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
The covered scan is a single low-dose CT (LDCT) of the chest, once per year. No other imaging counts under this coverage rule.
The Counseling Visit Before Your First Scan
Before your very first LDCT screening, Medicare requires a counseling and shared decision-making visit with a physician, nurse practitioner, physician assistant, or clinical nurse specialist. This visit is a coverage condition, not a suggestion, and it has to be documented in your medical record.
The practitioner has to cover specific ground during that visit: the benefits and harms of screening, the false-positive rate and what follow-up looks like, the cumulative radiation exposure, and how any other health conditions might affect your willingness or ability to pursue diagnosis and treatment if something is found. If you currently smoke, the practitioner also has to counsel you on cessation and, when appropriate, share information about tobacco cessation programs. If you’ve already quit, the counseling turns to staying smoke-free. At least one decision aid, which is a tool for weighing the trade-offs, must be part of the visit.1Centers for Medicare & Medicaid Services. National Coverage Determination for Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
If you decide to go ahead, the practitioner writes the order for the LDCT.
For each annual screening after that first one, the full counseling visit is not required again. You need only a new written order from a qualified practitioner, and that can happen at any appropriate office visit.2Centers for Medicare & Medicaid Services. CMS Transmittal R185NCD – Medicare National Coverage Determinations
What the Written Order Has to Say
Every LDCT screening, first or annual, needs a written order in your medical record. That order must include:
- Your date of birth.
- Your smoking history as an actual pack-year number, not a general statement.
- Your current smoking status, and if you’re a former smoker, how many years since you quit.
- A statement that you have no signs or symptoms of lung cancer.
- The National Provider Identifier (NPI) of the ordering practitioner.
Missing any piece of this can get the claim denied, so it’s worth confirming with the ordering office that the order is complete before you go for the scan.2Centers for Medicare & Medicaid Services. CMS Transmittal R185NCD – Medicare National Coverage Determinations
What You Pay
If you meet the eligibility criteria and the provider accepts Medicare assignment, you pay nothing for the screening. No deductible, no coinsurance. Assignment means the provider has agreed to accept Medicare’s approved amount as full payment. If the provider doesn’t accept assignment, you may owe additional charges.3Medicare.gov. Lung Cancer Screenings
The zero-cost rule covers the screening scan itself. It does not cover what happens next if something shows up. If the LDCT finds something suspicious and you need diagnostic follow-up, such as a full-dose CT, a PET scan, or a biopsy, those are billed as standard diagnostic care under Part B. That means the 2026 Part B deductible of $283 applies, and after the deductible you generally pay 20 percent coinsurance.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles People are often surprised by this, because one preventive scan can turn into weeks of paid follow-up.
Medicare Advantage and Private Coverage
Medicare Advantage plans have to cover the same preventive services as Original Medicare, LDCT lung cancer screening included, at no cost. The catch is the network. Advantage plans use provider networks, and going outside the network can convert a zero-cost screening into one with charges you weren’t expecting. Confirm before you schedule that both the ordering practitioner and the imaging facility are in-network for your plan.
If you’re on private insurance rather than Medicare, the eligibility window is wider on the top end. The U.S. Preventive Services Task Force recommends LDCT screening for adults 50 to 80, and most private plans have to cover Task Force “A” and “B” preventive recommendations without cost-sharing. That mandate was upheld by the U.S. Supreme Court in June 2025 in Kennedy v. Braidwood Management. The practical takeaway: a 79-year-old on employer coverage may still get a no-cost screening that Medicare, capped at 77, would not pay for.
If Your Claim Gets Denied
Denials happen, most often because of incomplete documentation on the written order or a dispute about whether you met all the criteria on the day of the scan. You have appeal rights, and there are five levels.
Start with a redetermination request filed with the Medicare Administrative Contractor that processed the claim. You have 120 days from the date on the initial determination notice, and the contractor generally decides within 60 days.5Centers for Medicare & Medicaid Services. Medicare Parts A and B Appeals Process If that goes against you, four more levels are available, up through federal court review for claims meeting the 2026 minimum of $1,960.6Medicare.gov. Filing an Appeal
Your State Health Insurance Assistance Program (SHIP) offers free counseling on appeals, and you can appoint a family member or other representative to handle the process for you.