CMS proposes coverage of low-dose CT screening for high-risk patients

by Lauren Dubinsky, Senior Reporter | November 13, 2014
The announcement the industry has been waiting for came on Monday when CMS proposed covering low-dose computed tomography (LDCT) screening for eligible patients.

In a statement, the agency reported that there is "sufficient evidence" to cover screening once per year if the patient is between 55 and 74 years old, has no symptoms of lung disease, has a smoking history of at least 30 pack-years and is a current smoker or has quit smoking in the past 15 years.

The patient must undergo lung cancer screening counseling and a shared decision-making visit with a physician or qualified non-physician practitioner to determine their eligibility.
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The USPSTF released its final recommendations last December that graded annual LDCT for those at high-risk of lung cancer with a B. The Affordable Care Act requires private insurers to cover prevention measures graded A or B, so starting January 1, 2015 they are required to cover it. However, since that doesn't apply to Medicare, many patients would have had to pay out of pocket if CMS refused to cover it.

CMS' decision is contrary to the recommendations their advisory panel made in April. They advised against covering LDCT for high-risk patients because they felt there wasn't adequate evidence showing its benefits over its harms.

Since then, organizations such as the American College of Radiology and the Lung Cancer Alliance increased their lobbying efforts. This week's announcement is a major victory for them.

"CT lung cancer screening is the first and only cost-effective test proven to significantly reduce lung cancer deaths," Dr. Ella Kazerooni, chair of the ACR Lung Cancer Screening Committee and ACR Thoracic Imaging Panel," said in a statement. "Medicare coverage provides access to care for seniors and will help physicians save thousands of lives each year from the nation's leading cancer killer."

CMS is currently seeking comments on their proposed decision. ACR stated that they will apply to be a Medicare-recognized registry and will work with stakeholders to submit comments.

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