Medicare to Cover Lung Cancer CT Screening, CMS Announces

February 10, 2015 02:31 pm News Staff
[Doctors looking at x-ray of lungs]

Effective Feb. 5, certain Medicare beneficiaries gained coverage for lung cancer screening with low-dose CT scans.

According to a CMS press release, the coverage is a first for this particular disease.

"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," said CMS Chief Medical Officer Patrick Conway, M.D.

To qualify for the once-per-year benefit, patients must be 55 to 77 years old. Additionally, Medicare beneficiaries must

  • currently smoke tobacco products or have quit within the past 15 years,
  • have smoked an average of one pack of cigarettes a day for 30 years, and
  • have a physician or other health care professional's written order requesting the test.

Medicare coverage includes an office visit dedicated to patient counseling on tobacco-related issues and a conversation about the relative harms and benefits of lung cancer screening.

The pros and cons of lung cancer screening for patients in this age group have been hot discussion topics among physicians and other stakeholders since at least the summer of 2013.

In July of that year, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation proposing that physicians annually screen high-risk 55- to 79-year-olds using low-dose CT scans. The USPSTF definition of high-risk adults mirrored that of smokers described in the recent CMS announcement.

That draft proposal became an official recommendation( in December 2013.

The following month, the AAFP said there was insufficient evidence to recommend either for or against low-dose CT scans to screen high-risk older smokers for lung cancer.

More dissent came in May 2014, when the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) recommended against Medicare coverage for the procedure. Again, the decision was based on a lack of evidence to support the benefits versus the harms of screening.

When all was said and done, the final coverage decision was left to CMS, as summed up by Conway in last week's press release.

"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," he said.