CMS issues final decision approving Medicare coverage of LDCT lung cancer screening

The Centers for Medicare and Medicaid Services (CMS) Thursday issued a final national coverage determination for Medicare coverage of screening for lung cancer with low dose computed tomography (LDCT).  Coverage is to go into effect immediately.

CMS will now cover the exam for individuals between 55-77 years of age with a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes). Patients will also have to receive a written order from a physician or qualified non-physician practitioner that meets certain requirements.

“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 deaths in the United States,” said Patrick Conway, MD, chief medical officer and deputy administrator for innovation and quality for CMS, in a statement. ““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.”

The decision to cover individuals between the ages 55 and 77 represents a change from the draft decision memo issued by CMS in November when it proposed to cover individuals between the age of 55 and 74. 

“The USPSTF had recommended up to 80, and the NLST (National Lung Screening Trial) was performed up to 74, so it seems like [CMS] split the difference,” said Ella Kazerooni, MD, chair of the American College of Radiology Lung Cancer Screening Committee and the American College of Radiology Thoracic Imaging Panel, in an interview with Radiology Business Journal. “The reason USPSTF went up to 80 was because the average age of persons with lung cancer is in the 70s, and over half the people with lung cancer are diagnosed after 70. They also did additional modeling studies to show it could be effective [in that age group]. So we really pushed Medicare to go up from 74. I wish they had gone up to 80, but 77 is better than 74.”

There were also some other changes in the final coverage determination that Kazerooni said were significant. In the proposed decision memo, for example, eligibility criteria included a provision that a patient must have no signs of symptoms of lung disease. “We all know that most people who smoke cough, and coughing is a symptom of lung disease,” said Kazerooni. “So they changed it." That eligibilty requirement now reads that the patient must have no signs or symptoms of lung cancer, specifically.

Overall, Kazerooni said, “Medicare really listened to the science, and really listened to all the professional and patient advocacy groups that came forward over the past year to give feedback every step of the way.  And they listened to the feedback we gave to their draft coverage decision in November, and they made a lot of changes that were suggested. So hats off to Medicare for doing the right thing.”

“It’s a great day,” she added. “I’m going to be practicing radiology for another 15 or 20 years, and it would be great when I retire if lung cancer is no longer the death sentence it is today because of this decision.”