ACR, 40 other orgs urge CMS to cover lung cancer screening

The American College of Radiology, along with 40 other medical organizations, is calling on the Centers for Medicare & Medicaid Services to provide Medicare coverage of low-dose CT screening for patients at high-risk for lung cancer.

In a letter sent March 12 to Tamara S. Syrek Jensen, acting director of CMS' coverage and analysis group, the organizations said they "strongly support national coverage for lung cancer screening of high risk individuals with lose dose computed tomography in light of the robust scientific evidence outline in the United States Preventive Services Task Force's final [B] recommendation."

USPSTF issued its recommendation last December.

The coalition wants CMS not only to provide full national Medicare coverage for the at-risk group, as defined in the USPSTF recommendation (adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit in the last 15 years), but also to provide coverage with evidence for other high-risk groups using data collected through existing registries.

In an announcement, the groups warned that while the Affordable Care Act requires private insurers to provide national coverage for medical exams and procedures that receive a grade B or higher from USPSTF without a co-pay, it doesn't specify that Medicare provide full national coverage for beneficiaries.

"The USPSTF's recommendation that made lung cancer screening an essential health benefit specifically included 65 to 80 year olds who are also part of the Medicare population," Lung Cancer Alliance President and Chief Executive Officer Laurie Fenton Ambrose said. "If Medicare does not extend full coverage for lung cancer screening to this population, the net effect will be a two tier system that leaves Medicare beneficiaries at greater risk of dying from lung cancer than those with private insurance. This cannot be right." 

By acting on the USPSTF recommendation, CMS would support quality screening programs on a national basis, said Paul Ellenbogen, chair of the ACR Board of Chancellors. "This would, for the first time, enable healers and patients to strike a major blow against the nation's leading cancer killer." 

The comment period for the proposal to make CT screening for high-risk individuals one of Medicare's covered preventive services ended March 12. CMS plans on holding a Medicare Evidence Development and Coverage Advisory Committee meeting in April to review evidence on CT lung cancer screening.

To learn more:
- read the letter (.pdf)
- check out the announcement

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