Referring Providers

If you have questions regarding these processes, please call us at 1-877-728-4543 or email the UR Medicine Lung Cancer Screening Clinic.

Current Inclusion Criteria

• Age 50-80
• Cigarette smoking history of 20 pack years minimum
  • Examples: (1 pack/day x 20 years = 20 pack years) or (1 pack/day x 10 years + .5 pack/day x 20 years = 20 pack years)
• Current cigarette smoker or has quit in 15 years or less
• Asymptomatic for lung cancer

Option 1

I wish to enroll my patient into the UR Medicine Lung Cancer Screening Program. In order to satisfy the program requirements and CMS compliance, the following is required.

• Patient is asymptomatic
• Lung Cancer Screening - Shared decision-making counseling documented and charged (G-0296)
• Smoking cessation counseling provided and documented
• Low Dose CT scan ordered (CPT-71271)
  • Via eRecord order
  • If not on eRecord, via LCS requisition form 

Option 2

I wish to refer my patient for screening, counseling, and entry into the UR Medicine Lung Cancer Screening Program via the UR Medicine Lung Cancer Screening Clinic.

Referral Options

• Referrals can be made in eRecord workflow (Pulmonary Referral/Lung Cancer Screening Clinic)
• Fax requisition form to (585) 784-7954
• Call the UR Medicine Lung Cancer Screening Clinic at (877) 728-4543 
• Email the UR Medicine Lung Cancer Screening Clinic