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CMS Approves Medicare Coverage for Lung Cancer Screening

Action marks first time Medicare pays for low-dose CT scans

The Centers for Medicare & Medicaid Services (CMS) has issued a final national coverage determination (NCD) that provides Medicare coverage of screening for lung cancer with low-dose computed tomography (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,” said Dr. Patrick Conway, chief medical officer 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 of age, 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 a day for 30 years).
  • They have received a written order from a physician or a qualified non-physician 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 NCD also includes required data collection and specific coverage eligibility criteria for radiologists and radiology imaging centers, consistent with the National Lung Screening Trial protocol, with the U.S. Preventive Services Task Force recommendation, and with multi-society, multi-disciplinary 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 said.

Source: CMS; February 5, 2015.

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