CMS says evidence is sufficient to expand Medicare coverage for low-dose CT lung cancer screening
The Centers for Medicare & Medicaid Services believes there is sufficient evidence to warrant expanding eligibility for lung cancer screening via low-dose CT, the agency announced on Wednesday.
Under the proposal, Medicare beneficiaries between the ages of 50 to 77 would be eligible, a drop from the previous starting age at 55. CMS also plans to reduce the threshold from 30 pack-years down to 20—meaning 20 cigarettes smoked per day for the past two decades. The new coverage guidelines align with recently updated recommendations from the U.S. Preventive Services Task force, released in March.
In explaining the decision, the agency said cancer of the lung and bronchus has accounted for 130,000 deaths in 2021, more than colon, breast and prostate cancer combined. It also cited results from high-profile lung cancer trials, demonstrating CT screening’s benefits.
“The evidence is sufficient to conclude that broadening the eligibility criteria for lung cancer screening with low dose CT is reasonable and necessary for the prevention or early detection of illness or disability and appropriate for Medicare beneficiaries under conditions established in this [national coverage determination],” CMS said Nov. 17.
Other eligibility criteria include displaying no lung cancer symptoms, being a current smoker or one who has quit in the last 15 years, and receiving an order for LDCT. Prior to the first screening, Medicare beneficiaries must schedule an appointment to help determine eligibility, discuss decisions in the process, and receive counseling on smoking cessation. CMS said the clinical evidence is “insufficient” to extend the age range beyond 77 to 80. Meanwhile, radiologists can participate if they are board-certified (or eligible) and have documented participation in continuing medical education.
The agency first announced it was launching its coverage review back in May and said it hoped to have a decision in November and complete the process by February 2022. A study in JAMA Network last month estimated that broadening LDCT recommendations to match the USPSTF’s guidelines could spell a 54% surge in eligibility. CMS also recently announced plans to raise the rate for outpatient lung cancer screening by more than 37%.
The feds are seeking comment on the proposal, with plans to respond to any input in a forthcoming final decision memorandum. Those requesting the National Coverage Determination reconsideration in March included the GO2 Foundation for Lung Cancer, Society of Thoracic Surgeons, and the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.