Total-Body CT Screening (CPB 0603, reviewed 2025-12-02)

By December 2, 2025: (1) Billing team must update claim submission rules in billing software to flag or deny HCPCS code S8092 (electron beam computed tomography/ultrafast CT) when billed for screening purposes on asymptomatic patients. (2) Implement front-end edits to require providers to document specific clinical indication (symptoms, family history, or diagnostic purpose) on all total-body CT orders before claims are processed. (3) Create denial template explaining that screening total-body CT is not a covered benefit per CPB 0603. (4) Providers must be notified that S8092 will only be considered for diagnostic purposes (e.g., trauma, staging of known disease like CLL) with appropriate clinical documentation; screening claims will be denied. (5) Update superbill/encounter forms to distinguish between diagnostic total-body CT (potentially covered) and screening total-body CT (not covered). Failure to implement these edits will result in increased claim denials and potential recoupment of paid screening claims.