Medicare To Cover Low-Dose CT Scans for Lung Cancer Screening

On Thursday, CMS issued a national coverage determination announcing coverage of low-dose CT scans for lung cancer screening for certain Medicare beneficiaries, Modern Healthcare reports (Rice, Modern Healthcare, 2/5).

Coverage Determination Details

CMS last year proposed covering the scans for Medicare beneficiaries ages 55 to 74 who have a history of heavy smoking (California Healthline, 11/11/14). Under the final coverage determination, Medicare will cover annual CT scans for beneficiaries who:

• Are between ages 55 and 77;
• Currently smoke or have quit smoking within the past 15 years and have a smoking history of 30 "pack years" or more, meaning they averaged at least one pack daily for 30 years; and
• Receive written orders from a provider (Modern Healthcare, 2/5).

The coverage takes effect immediately (Adams, CQ Roll Call, 2/5). The coverage change is expected to cost about $9.3 billion over the next five years. The cost estimate includes the value of the scans, biopsies and treatments (Modern Healthcare, 2/5).

In addition, the coverage determination stipulates that radiology facilities performing the scans submit data on all patients screened to a CMS-approved registry. The data, among other information, must detail patients':

• CT dosage;
• Indication for the screening; and
• Smoking history and status (Gever, "The Gupta Guide," MedPage Today, 2/5).

Debate Over Procedure

According to Modern Healthcare, the decision has come as the benefits of such screenings are being debated. Some critics have said that benefits of the tests have been exaggerated, while others have said creating appropriate screening programs is complex.

However, supporters of the screenings argue that the tests can help save thousands of lives and bolster understanding of lung cancer.

CMS Chief Medical Officer and Deputy Administrator Patrick Conway said, "We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program" (Modern Healthcare, 2/5). He added that the coverage is "an important new Medicare preventive benefit since lung cancer is the third-most-common cancer and the leading cause of cancer deaths in the [U.S.]" (Begley, Reuters, 2/5).

Patient Advocates, Radiology Groups Welcome Change

Patient advocates and radiology organizations applauded the decision as the "first major blow against lung cancer" (Modern Healthcare, 2/5). Medical Imaging & Technology Alliance Executive Director Gail Rodriguez added that the move will give "Medicare beneficiaries who are at high-risk for lung cancer ... access to life-saving scans" (CQ Roll Call, 2/5). She added, "Given the high bar CMS holds in making national coverage determinations, it is clear that the benefits of [CT] scans for those at high risk of lung cancer are indisputable" (Viebeck, The Hill, 2/5).