Medicare Begins Coverage of Lung Cancer Screening for High-Risk Individuals

Medicare will immediately cover lung cancer screening with low-dose computed tomography (LDCT) for high-risk individuals, including current and former smokers, according to a national coverage determination (NCD) released by CMS.

Medicare will immediately cover lung cancer screening with low-dose computed tomography (LDCT) for high-risk individuals, including current and former smokers, according to a national coverage determination (NCD) released by CMS.

The decision to cover the procedure was announced in November 2014, following months of consternation after the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) voted against coverage in late April 2014.

[Read “Medicare to Cover Lung Cancer Screening” from Nov. 11, 2014 ]

“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,” Patrick Conway, chief medical officer and deputy administrator for innovation and quality for CMS, said in a statement.

The decision will allow Medicare beneficiaries aged 55 to 77 who are either current smokers or have quit smoking within the past 15 years to receive LDCT screening once a year. This includes those with a tobacco smoking history of at least 30-pack years, which is at least a pack a day for 30 years (for example, if a person smoked two packs a day for 15 years, that equals 30-pack years). Additionally, the individual must have a written order from a physician or qualified non-physician practitioner that meets certain requirements, which are contained in the NCD.

Coverage will include a visit for counseling on the benefits and risks of LDCT screening. The announcement also included data collection and eligibility requirements for radiologists and imaging centers consistent with the National Lung Screening Trial (NLST) Protocol.

“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.

The CMS announcement comes a little more than a year after the US Preventive Services Task Force (USPSTF) finalized its “B” recommendation for annual lung cancer screenings with LDCT; that recommendation was for adults aged 55 to 80 who had smoked 30-pack years. USPSTF’s recommendation was based on results of the NLST, which found that patients who received screening had a 15 percent to 20 percent lower risk of dying from lung cancer; results published in 2013 showed that targeting screening toward those at greatest risk produced the most effective results.

The decision to pay for widespread screening is not without controversy. In a paper published in JAMA Internal Medicine in December 2014, authors expressly discouraged CMS from paying for screening. This is difficult under the Affordable Care Act, since the law requires commercial insurers to pay due to the B recommendation. The authors argued that screening in the general population may not be limited to high-risk smokers outside a clinical trial, and may cause unnecessary harm due to radiation and false positives. The authors also questioned whether screenings would be performed in qualified radiation centers.

Lung cancer is the leading cause of cancer death in the United States; according to the CDC, with nearly 157,000 people in the United States dying from lung cancer in 2011. The vast majority of deaths from lung cancer are caused by tobacco use.