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CMS now covers lung cancer screening for Medicare beneficiaries

February 5, 2015
by Lois A. Bowers, Senior Editor
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The Centers for Medicare & Medicaid Services (CMS) now will cover lung cancer screening with low-dose computed tomography for Medicare beneficiaries—with certain conditions. The coverage, announced Feb. 5, is effective immediately.

“This is the first time that Medicare has covered lung cancer screening,” Patrick Conway, MD, MSc, chief medical officer and deputy administrator for innovation and quality for CMS, said in a statement. “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.” As Long-Term Living previously reported, the agency first proposed the coverage in November.

The news was met with applause from the American Lung Association. “Today, Medicare announced action that will save lives and increase the low survival rates associated with lung cancer, our nation’s leading cancer killer,” Harold P. Wimmer, the organization’s national president and CEO, said in a statement. The association said it will thoroughly analyze CMS’ national coverage determination and will post additional information on its website.

Medicare will cover the screening once per year for Medicare beneficiaries who meet all of the following criteria:

  • They are aged 55 to 77 years and are either current smokers or have quit smoking within the past 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 receive a written order from a physician or qualified non-physician practitioner that meets certain requirements.

The coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening. The national coverage determination also includes required data collection and specific coverage eligibility criteria for radiologists and radiology imaging centers, consistent with the National Lung Screening Trial protocol, U.S. Preventive Services Task Force recommendation and multisociety, multidisciplinary 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.

See the CMS decision memo.