Medicare Compliance & Reimbursement

CMS takes bold step to reduce lung cancer mortality of patients.

The Centers for Medicare & Medicaid Services (CMS) sprang a welcome surprise on Feb. 5 when it announced that lung cancer screenings using low dose computed tomography (LDCT) will be covered by Medicare immediately.

Medicare patients will be eligible for the lung cancer screening annually if they meet the criteria below:

• Age 55 to 77;
• Show no signs or symptoms of lung cancer;
• Either current smokers or quit within the past 15 years;
• Tobacco smoking history of at least one pack a day for 30 years;
• Have a written order from their provider.

Prior to the first screening, the physician and patient should participate in a counseling session discussing the benefits of screening as well as the importance of abstaining from smoking. In addition, if the patient is still smoking, the practitioner must discuss the benefits of smoking cessation counseling with the patient. Some people are calling the screening the equivalent to a “smoker’s mammogram” because of how effective it’s intended to be in catching lung cancer earlier than in the past.

“This is the first time that Medicare has covered lung cancer screening,” said Patrick Conway, MD, CMS’s chief medical officer, in a statement. “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.”

Many specialty societies applauded the news of the screening. “CMS has taken a bold step that can potentially reduce the lung cancer mortality of patients at highest risk for lung cancer by nearly 20 percent” said Bruce G. Haffty, MD, chair of the American Society for Radiation Oncology, in a Feb. 9 statement. “We are grateful for the additional opportunities that annual screening provides us to save hundreds of thousands of lives from lung cancer.”

Resource: To read the complete CMS Decision Memo outlining the requirements for LDCT screening, visit www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274.