CMS Broadens Coverage of Lung Cancer Screening

The national coverage determination will help detect early non-small cell lung cancer, CMS said.

CMS announced Thursday it will expand coverage for lung cancer screening completed via low dose computed technology (LDCT). The national coverage determination (NCD) aims to improve early detection of non-small cell lung cancer (NSCLC), which accounts for around 85% of all lung cancer cases.

Lung cancer in general is the leading cause of cancer-related deaths in the United States. Previously, Medicare beneficiaries could have the procedure covered beginning at age 55. Under the new rule, individuals aged 50 to 77 are eligible, while tobacco smoking history has been lowered from at least 30 packs per year to at least 20 packs per year.

In addition, the NCD simplifies requirements for the counseling and shared decision making visit beneficiaries must complete prior to screening.

Beneficiaries must complete the visit, documented in their medical records, that includes counseling on the importance of annual LDCT screening and maintaining cigarette smoking abstinence or smoking cessation if a current smoker, among other criteria.

The NCD also “removes the requirement for the reading radiologist to document participation in continuing medical education, thereby reducing administrative burden on providers,” the CMS statement reads, while a requirement was also added mandating radiology imaging facilities use a standardized lung nodule identification, classification, and reporting system.

The decision follows a 2021 update from the United States Preventive Services Task Force (USPSTF) which recommends yearly LDCT scans for people aged 50 to 80 years old and reduced the pack-years of smoking history from 30 to 20. A pack-year is the equivalent of smoking an average of 1 pack of cigarettes each day for a year.

Previous research revealed this updated guidance helped mitigate racial disparities in screening access, but barriers remained.

“According to the Patient Protection and Affordable Care Act, a grade B recommendation by the USPSTF automatically qualifies one for coverage by Medicare and Medicaid, but as of 2019, only 31 state Medicaid programs confirm coverage of screening for lung cancer,” wrote Jonathan A. Nitz, MD, and Cherie P. Erkmen, MD, in an accompanying commentary published in January—prior to the NCD announcement.

“Lack of clarity in screening recommendations and payment likely impedes the uptake of lung cancer screening, especially among marginalized populations,” they said.

“Expanding coverage broadens access for lung cancer screening to at-risk populations,” said CMS chief medical officer and director of the Center for Clinical Standards and Quality, Lee Fleisher, MD, of the NCD announcement.

“Today’s decision not only expands access to quality care but is also critical to improving health outcomes for people by helping to detect lung cancer earlier.”