Medicare Says "Yes" to LDCT in Lung Cancer

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CMS announced today that low-dose computed tomography screening will now be reimbursed once a year by Medicare as a preventive service benefit, despite an advisory panel recommending against the screening back in April 2014.

Medicare announced today that it will cover low-dose computed tomography (LDCT) screening. The memo released today by CMS states that the available evidence is sufficient to include preventive LDCT once a year as an additional preventive service benefit. The coverage benefit, of course, has to be met with certain criteria that have been laid down by the CMS. The beneficiary must be:

  1. 55 to 74 years of age
  1. Asymptomatic for lung disease
  2. Current smoker or should have quit smoking within the last 15 years.

Further, the initial screen would require a written order for LDCT during a lung cancer screening counseling and shared decision making visit, furnished by a physician or qualified physician practitioner. For subsequent screens, the beneficiary must receive a written order, which may be furnished during any appropriate visit with a physician or qualified physician practitioner.

Additionally, the screening radiologist and the imaging center have to meet certain eligibility criteria for the coverage decision to be made.

This announcement contradicts the recommendation by a CMS advisory panel back in April 2014. The panel concluded that annual LDCT lung cancer screening for high-risk individuals doesn't have enough evidence for benefit over harms to be covered by.

The proposed coverage decision is now open for public comments.