CMS Will Cover Annual Lung Cancer Screening

The Center for Medicare and Medicaid Services (CMS) released a national coverage determination last week regarding annual lung cancer screening for eligible beneficiaries. Coverage is effective immediately. The Medicare program will cover lung cancer screening with low dose computed tomography (LDCT) for beneficiaries between the ages of 55 – 77 years who have no signs or symptoms of lung cancer, but either have a smoking history of at least 30 years of smoking one pack per day, the beneficiary is a current smoker, or one who has quit smoking within the last 15 years.

The beneficiary may receive a written order for the screening by a physician or qualified non-physician practitioner during a lung cancer screening counseling and shared decision making visit. The visit must include the following elements document in the medical record:

• Determination of beneficiary eligibility: including age, absence of signs or symptoms of lung cancer, a specific calculation of cigarette smoking pack-years; if a former smoker and the number of years since quitting;

• Shared decision making: including the use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate and total radiation exposure;

• Counseling: on the importance of adherence to annual lung cancer LDCT screening, impact of comorbidities and ability or willingness to undergo diagnosis and treatment; the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions; and

• A written order: if determined that the screening is appropriate.

Subsequent screenings can be ordered during any appropriate visit with a physician or non-physician practitioner without counseling and shared decision making as outlined above. The coverage determination also includes criteria for the written order and eligibility of the reading radiologist and radiology imaging facility.

In 2011, the National Lung Screening Trial (NLST) showed that people aged 55 to 74 years with a history of heavy smoking are 20 percent less likely to die from lung cancer if they are screened with LDCT than with standard screening chest x-rays. Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality for CMS said, “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.” According to the Lung Cancer Alliance, the new Medicare coverage brings the benefit of screening to approximately five million American seniors, the most at-risk group for lung cancer.

For more information regarding this advisory, contact Laura F. Fryan in Brouse McDowell's Health Care practice group.