Medicare Proposes Covering CT Screening for Lung Cancer

Medicare has released its proposed decision on lung cancer screening using low dose computed tomography (LDCT), saying the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, using the technology to screen once per year.

CMS proposed the benefit under Medicare as long all of the following criteria are met:

• Age 55-74 years;
• No signs or symptoms of lung disease;
• Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);
• Current smoker or one who has quit smoking within the last 15 years.

In addition, patients undergoing screening with LDCT would  have a “lung cancer screening counseling and shared decision-making visit” from their health care provider.

The CMS coverage decision will also require that centers meet defined standards in order to be eligible to receive CMS payment for screening. Centers will be responsible for establishing a patient registry that documents risk factors and the results of screening, as well as inclusion of tobacco cessation services.

Richard C. Wender, M.D.

Richard C. Wender, M.D., the American Cancer Society’s Chief Cancer Control Officer, had this to say about the news:

“The American Cancer Society is pleased that the Centers for Medicare and Medicaid Services (CMS) today issued a proposed decision providing coverage for lung cancer screening for appropriate high risk Medicare beneficiaries nationwide. Although CMS will evaluate additional comments before issuing a final rule and actually offer coverage under Medicare, this decision likely means that thousands of Medicare beneficiaries will have access to this important and potentially life saving service. This would place Medicare policy in line with current guidelines and the recommendations of many interested advocacy and professional organizations, including the Society.

“The American Cancer Society joined with several professional societies, including the American College of Radiology, the American Thoracic Society, and the American College of Chest Physicians to promote a quality framework that helped shape the CMS decision.

“We will now focus our efforts on helping the nation build capacity to deliver high quality screening in as many centers as possible so that high quality lung cancer screening is available to everyone who meets screening criteria. We are committed to serving as the convening organization for this capacity building work. The cooperation of many organizations to commit to and promote a quality framework signals a broad national commitment to delivering only high quality screening to the patients who are most likely to benefit.

“We join many others who share the hope that this decision will mean that many lives will be saved from a premature death related to lung cancer, and that many others will receive the information and help they may need to discontinue smoking and other forms of tobacco consumption.”

You can read more about lung cancer early detection, including the American Cancer Society’s Guidelines, on our web site.