CMS released a final national coverage determination that covers low-dose CT lung cancer screening for Medicare beneficiaries who meet risk criteria.
The determination — which follows a draft guidance issued in November 2014 — provides yearly screening for Medicare beneficiaries aged 55 to 77 years who have a 30 pack-year smoking history and either currently smoke or have quit within the past 15 years.
Those who meet these requirements also must undergo counseling on smoking cessation. They also must have a shared decision-making discussion with a physician or qualified non-physician practitioner about the risks and benefits of lung cancer screening. Once those requirements are met, a provider can supply the beneficiary with a written order for screening.
“This is the first time that Medicare has covered lung cancer screening,” Patrick Conway, MD, MSc, chief medical officer and deputy administrator for innovation and quality for CMS, said in a press release. “This 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 United States.”
The national coverage determination requires that radiologists and radiology imaging centers meet certain eligibility requirements, including that they utilize a standardized lung nodule identification, classification and reporting system and make available smoking cessation interventions to beneficiaries who still smoke. All data from each lung cancer screening also must be collected and reported to a CMS-approved registry.
“The requirements for the radiology imaging center will help ensure that the screening exam is properly performed and interpreted,” William C. Black, MD, chest radiologist at Dartmouth-Hitchcock Norris Cotton Cancer Center and professor of radiology at Geisel School of Medicine at Dartmouth College, told HemOnc Today at the time the draft guidance was issued. “The creation of a registry will enable review of real-world screening processes and outcomes, [allowing] opportunities for future improvements.”
The CMS decision followed an April 2014 recommendation from the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) — a CMS advisory panel — not to provide Medicare coverage for lung cancer screening. Although the US Preventive Services Task Force recommended annual low-dose CT screening for adults aged 55 to 80 who meet high-risk criteria with a grade of “B,” MEDCAC members expressed low to intermediate confidence that the advantages of annual screening with low-dose CT outweighed the potential risks.
“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,” Conway said.
For more information:
CMS. Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography. Available at: www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed on Feb. 6, 2015.