CMS Announces Proposed Decision to Cover Low-Dose CT Screening for Lung Cancer
The Centers for Medicare & Medicaid Services (CMS) announced today that there is sufficient evidence to cover lung cancer screening with low-dose computed tomography (CT) screening for individuals at high risk for lung cancer.
Earlier this year, the U.S. Preventive Services Task Force recommended (with a grade of “B”) low-dose CT screening for lung cancer for adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The proposed CMS decision narrows coverage to those aged 55 to 74 and requires providers to submit clinical and follow-up data to an approved registry.
Additional Eligibility Requirements
In order to be eligible for these benefits under the Medicare program, the beneficiary must receive a written order for the initial low-dose CT lung cancer screening during a lung cancer screening counseling and shared decision-making visit. During this visit, a physician or qualified nonphysician practitioner will determine the beneficiary’s eligibility and discuss the risks and benefits of the procedure, any follow-up testing, overdiagnosis, diagnosis, and treatment. Individuals will be counseled on the importance of adherence to annual screening, the impact of comorbidities, the importance of abstaining from cigarette smoking or smoking cessation if a current smoker, and other issues.
On subsequent screenings, the beneficiary may provide a written order from any appropriate visit with a physician or qualified practitioner.
In addition, radiology imaging centers must meet eligibility criteria in order for screening to be covered under Medicare. Eligible facilities will have participated in past lung cancer screening trials or be an accredited advanced diagnostic imaging center with experience in low-dose CT screening, and must use an effective radiation dose of less than 1.5 mSv. These facilities must submit data to a CMS-approved national registry for each low-dose CT lung cancer screening performed.
For the full text of the proposed CMS decision, visit http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=274. CMS will issue a final decision after a 30-day comment period.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
