CMS approves Medicare coverage of LDCT lung cancer screening

Despite a negative recommendation from its own review panel, the Centers for Medicare & Medicaid Services (CMS) Monday issued a proposed decision memo approving low-dose CT (LDCT) screening for Medicare patients.

In April, the Medicare Evidence Development & Coverage Advisory Committee gave LDCT lung cancer screening a low-confidence vote, seemingly setting up the likelihood that CMS would not cover the screening exams. Since that time, however, there has been a tremendous lobbying effort in support of LDCT screening by healthcare professionals, screening advocates and organizations such as the Lung Cancer Alliance the American College of Radiology (ACR).

"Lung cancer will kill 160,000 Americans this year--more than breast, colon and prostate cancers combined," Ella Kazerooni, chair of the American College of Radiology Lung Cancer Screening Committee and the ACR's Thoracic Imaging Panel, said in an announcement. "Medicare coverage of these exams helps complete the first major blow against this terrible disease."

Lung Cancer Alliance President and CEO Laurie Fenton Ambrose added that the decision will save "tens of thousands of lives."

"By issuing this decision, CMS has avoided creating a perplexing two tiered system of coverage  where lung cancer screening is an essential health benefit for some but not for those at even higher risk for lung cancer--our nation's seniors," she said in a statement.

The CMS decision is slightly more restrictive than the decision issued last year by the United States Preventive Services Task Force (USPSTF) recommending LDCT lung cancer screening for at-risk patients. The USPSTF supports annual screening for adults between the ages of 55 and 80 who have a 30 pack-year smoking history and who currently smoke or have quit within the last 15 years.

Under the CMS decision, screening participants must be:

between the ages of 55 and 74, be asymptomatic, have a 30 pack-year smoking history and currently smoke or have stopped within the last 15 years. They can enter a lung-screening program only after undergoing a lung cancer screening, counseling and shared-decision making visit with a physician that includes smoking cessation counseling.

To participate in LDCT lung cancer screening, a radiologist must be American Board of Radiology certified, have documented training in diagnostic radiology and radiation safety, have been involved in the supervision and interpretation of at least 300 chest CT interpretations in the last three years, and have participated in continuing education medical education in accordance with ACR standards.

Eligible healthcare facilities must have participated in past lung cancer screenings, used LDCTs with an effective radiation dose of less than 1.5 mSv, and collect and submit data to a CMS-approved national registry for each screening performed.

To learn more:
- here's the proposed decision memo from CMS
- check out the announcement from the ACR
- read the statement from the Lung Cancer Alliance