Centers for Medicare & Medicaid Services To Cover Low Dose CT Lung Cancer Screening
The Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides for Medicare coverage of screening for lung cancer with low dose CT (LDCT). The coverage is effective immediately.

"This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States," says Patrick Conway, MD, MSc, CMO and deputy administrator for innovation and quality for CMS.

Medicare will now cover lung cancer screening with LDCT once per year for Medicare beneficiaries who meet all of the following criteria:

• they are 55 to 77 years old, and are either current smokers or have quit smoking within the last 15 years;
• they have a tobacco smoking history of at least 30 "pack years" (an average of one pack per day for 30 years); and
• they receive a written order from a physician or qualified nonphysician practitioner that meets certain requirements.

Medicare coverage includes a visit for counseling and shared decision making on the benefits and risks of lung cancer screening. The National Coverage Determination also includes required data collection and specific coverage eligibility criteria for radiologists and radiology imaging centers, consistent with the National Lung Screening Trial protocol, US Preventive Services Task Force recommendation, and multisociety multidisciplinary stakeholder evidence-based guidelines.

"We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program," Conway says.
— SOURCE: Centers for Medicare & Medicaid Services