News
Effective immediately, Medicare will cover annual lung cancer screening with low-dose CT for certain beneficiaries, according to a Feb. 5 national coverage determination.
To qualify, beneficiaries must be 55-77 years old, have a smoking history of at least a 30 pack-years, exhibit no signs or symptoms of lung cancer, and currently smoke or have quit within 15 years. They also must have a written screening order from their provider.
Dr. Patrick Conway
Coverage includes a counseling visit for shared decision-making, so patients know beforehand the “benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive[s], and total radiation exposure,” among other things, according to the decision memo from the Centers for Medicare & Medicaid Services.
Imaging centers are required to collect data on each screening and submit it to a CMS-approved registry.
The decision has been in the works for a while. In 2011, the National Cancer Institute–sponsored National Lung Screening Trial (NLST) showed that people aged 55-74 years with a history of heavy smoking are 20% less likely to die from lung cancer if they are screened with low-dose helical CT instead of standard chest x-ray (N. Engl. J. Med. 2011;365:395-409). Previous studies had shown that screening with standard chest x-rays does not reduce mortality from lung cancer.
Results from NLST and other studies prompted the U.S. Preventive Services Task Force in 2013 to recommend annual low-dose CT screening for adults aged 55-80 years with a 30 pack-year history; the recommendation in turn led to formal requests to CMS for coverage. In proposing coverage, the task force received almost 500 public comments “generally supportive of [expanding] Medicare coverage to include lung cancer screening,” it said.
Low-dose CT is performed at acquisition settings to minimize radiation exposure. For lung cancer screening, CMS is requiring a volumetric CT dose index (CTDIvol) of ≤ 3.0 mGy for standard-size patients – defined to be 5 feet 7 inches tall and approximately 155 pounds – with appropriate reductions or increases for smaller or larger patients.
