CMS proposes lung cancer screening with low-dose CT for high-risk patients

Medicare patients who are at high risk for lung cancer would be able to get screening using low-dose computed tomography under a proposed national coverage decision announced Nov. 10.

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CMS would strictly limit which patients could be screened for lung cancer via low-dose CT.

“The evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, screening for lung cancer with low-dose computed tomography, once per year, as an additional preventive service benefit under the Medicare program,” officials from the Centers for Medicare & Medicaid Services wrote in the proposed decision.

The agency would strictly limit eligibility criteria for low-dose CT screening. Appropriate patients would be 55-74 years old, show no signs of lung disease, and have a smoking history of at least 30 pack-years. Further, appropriate patients would be either current smokers or would have quit within the past 15 years. The written order for the low-dose CT screening must come after a lung cancer screening counseling and shared decision making visit with a physician or qualified nonphysician practitioner. Subsequent screenings orders could be received in writing during any appropriate visit.

The proposed coverage national decision comes despite a recommendation from the Medicare Evidence Development and Coverage Advisory Committee earlier this year to not cover low-dose CT screening. A study published Nov. 5 in the New England Journal of Medicine found low-dose CT screening cost effective for patients at high risk for lung cancer (2014;371:1793-802).

CMS will accept comments on the proposed coverage decision for 30 days, starting Nov. 10.

gtwachtman@frontlinemedcom.com