It's Final: CMS to Cover Lung Cancer Screening

Nick Mulcahy

February 06, 2015

Medicare will pay for lung cancer screening with low-dose CT (LDCT) for eligible patients, the Centers for Medicare & Medicaid Services (CMS) announced yesterday.

The coverage is effectively immediately.

The final national coverage determination had been anticipated since the agency made a preliminary decision to cover the screening in November 2014.

"This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit, since lung cancer is the third most common cancer and the leading cause of cancer death in the United States," said Patrick Conway, MD, chief medical officer and deputy administrator for innovation and quality at the CMS, in a press statement.

"Today, Medicare announced action that will save lives and increase the low survival rates associated with lung cancer, our nation's leading cancer killer," said Harold P. Wimmer, national president and CEO of the American Lung Association, in a press statement.

Medicare will pay for an annual lung cancer screen with LDCT for beneficiaries who are 55 to 77 years of age and who are either current smokers or quit smoking in the previous 15 years, who have a 30 pack-year history of tobacco smoking (an average of one pack a day for 30 years), and who have a written order from a physician or qualified nonphysician practitioner that meets certain requirements.

Notably, the coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening.

 
This is the first time that Medicare has covered lung cancer screening.
 

The new CMS policy also outlines the specific coverage-eligibility criteria for radiologists and radiology imaging centers and spells out what data will have to be collected as part of screening. Those criteria and requirements are consistent with the National Lung Screening Trial (NLST) protocol, US Preventive Services Task Force recommendation, and multisociety multidisciplinary stakeholder evidence-based guidelines, according to the CMS.

Approximately 4 million Medicare beneficiaries meet the eligibility criteria for screening, according to the nonprofit Lung Cancer Alliance.

The road to the coverage decision has been bumpy for advocates and proponents of lung cancer screening.

In April 2014, the Medicare Evidence Development & Coverage Advisory Committee voted against recommending national Medicare coverage for annual lung cancer screening with LDCT in high-risk individuals.

The ruling ignited intense pushback from healthcare professionals, patient advocates, and professional associations, as reported by Medscape Medical News. More than 40 medical societies urged the CMS to provide coverage for older adults. Even politicians entered the fray, with members of the US House and Senate asking CMS to reimburse for screening.

One of the criticisms of the screening is its very high rate of false positives.

In the landmark NLST, 96.4% of the positive screens in the LDCT group were false-positive results.

In the 53,000-person trial, there was a 20% reduction in death from lung cancer in current and former heavy smokers screened with LDCT, compared with chest radiograph (P = .004). The study, which was published in 2011 and is the primary evidence of the effectiveness of LDCT, had a median follow-up of 6.5 years.

The cost of lung cancer screening has also been questioned.

However, a 2014 analysis demonstrated that such a screening program could result in the detection of approximately 54,900 more cases of lung cancer during a 5-year period, most of which would be at an early, more treatable stage. This extrapolates to a cost increase of $9.3 billion, or an increase of $3 per month in beneficiary premiums.

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