The Centers for Medicare & Medicaid Services (CMS) proposes that the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, screening for lung cancer with low dose computed tomography (LDCT), once per year, as an additional preventive service benefit under the Medicare program only if all of the following criteria are met:
- Beneficiary eligibility criteria:
- Age 55-74 years;
- Asymptomatic (no signs or symptoms of lung disease);
- Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);
- Current smoker or one who has quit smoking within the last 15 years; and
- A written order for LDCT lung cancer screening that meets the certain criteria
Medicare's final decision to cover computed tomography (CT) lung cancer screening gives seniors at high-risk for the disease access to care that can save more lives than any cancer screening test in history.
"Medicare got this right. Screening coverage will help save thousands of seniors each year from the nation's leading cancer killer. Screening programs can also help lower smoking rates. The process may even lead to better understanding of addiction as well as lung cancer in those who have never smoked," said Laurie Fenton Ambrose, president and chief executive officer of the Lung Cancer Alliance (LCA).
CT lung cancer screening is the first and only cost-effective test proven to significantly reduce lung cancer deaths. More than 220,000 people will be diagnosed with lung cancer this year. Nearly 160,000 people will die from the disease - more than breast, colon and prostate cancers combined. This proven test, and the access to it that Medicare coverage allows, is a game changer in the battle against lung cancer.
"This is a great day for those at high-risk for lung cancer and their families. Now, we can save tens of thousands of people each year from this terrible disease that now kills more women in wealthy countries than breast cancer," said Douglas E. Wood, M.D., past president of The Society of Thoracic Surgeons.
The Centers for Medicare & Medicaid Services (CMS) will cover the exam for individuals age 55-77 years with a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes). CMS will require providers to submit clinical and follow-up data to an approved registry. The American College of Radiology (ACR) Lung Cancer Screening Registry has applied for CMS approval to help providers efficiently meet those registry reporting requirements.