Lung cancer is one of the most common cancers and the leading cause of cancer-related death in both men and women in the United States. This screening is aimed at the early detection of non-small cell lung cancer. On 10th Feb 2022, the Centers for Medicare & Medicaid Services (CMS) announced a national coverage determination (NCD) that expands coverage for lung cancer screening with low-dose computed tomography (LDCT) to improve health outcomes for people with lung cancer.
This final decision expands eligibility for people with Medicare to get lung cancer screening with LCDT by lowering the starting age for screening from 55 to 50 years and reducing the tobacco smoking history from at least 30 packs per year to at least 20 packs per year.
The only recommended screening test for lung cancer is LDCT, a unique computed tomography (CT) scan technique that combines special X-ray equipment with sophisticated computers to produce multiple, cross-sectional images of the inside of the body.
“Expanding coverage broadens access for lung cancer screening to at-risk populations,” said CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality, Dr. Lee Fleisher.
The final decision also simplifies requirements for the counseling and shared decision-making visit and, based on public comments received on the proposed NCD and additional review, removes the requirement for the reading radiologist to document participation in continuing medical education, thereby reducing the administrative burden on providers.
CMS also added a requirement back to the NCD criteria for radiology imaging facilities to use a standardized lung nodule identification, classification, and reporting system.
Summary of Expanded Coverage
The Centers for Medicare & Medicaid Services (CMS) reconsidered the national coverage determination established in section 210.14 of the Medicare National Coverage Determinations manual and has determined that the evidence is sufficient to expand the eligibility criteria for Medicare beneficiaries receiving low dose computed tomography (LDCT) when the following criteria are met:
Beneficiary Eligibility Criteria
- Age 50 – 77 years;
- Asymptomatic (no signs or symptoms of lung cancer);
- Tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);
- Current smoker or one who has quit smoking within the last 15 years; and
- Receive an order for lung cancer screening with LDCT.
Counseling and Shared Decision-Making Visit
Before the beneficiary’s first lung cancer LDCT screening, the beneficiary must receive counseling and a shared decision-making visit that meets all of the following criteria, and is appropriately documented in the beneficiary’s medical records:
- Determination of beneficiary eligibility;
- Shared decision-making, including the use of one or more decision aids;
- Counseling on the importance of adherence to annual lung cancer LDCT screening, the impact of comorbidities and ability or willingness to undergo diagnosis and treatment; and
- Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cessation if current smoker and, appropriate, furnishing of information about tobacco cessation interventions.
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Reading Lung Cancer Radiologist Eligibility Criteria
For purposes of Medicare coverage of lung cancer screening with LDCT, the reading radiologist must have board certification or board eligibility with the American Board of Radiology or equivalent organization.
Lung Cancer Radiology Imaging Facility Eligibility Criteria
For purposes of Medicare coverage, lung cancer screening with LDCT must be furnished in a radiology imaging facility that utilizes a standardized lung nodule identification, classification, and reporting system.
The above policy simplifies requirements for the counseling and shared decision-making visit, removes the restriction that it must be furnished by a physician or non-physician practitioner, reduces the eligibility criteria for the reading radiologist, and reduces the radiology imaging facility eligibility criteria (including removes the requirement that facilities participate in a registry). You can find a detailed decision and their background on the CMS website.
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FAQs
1. What is the purpose of the CMS’s decision on lung cancer screening?
The CMS expanded coverage for lung cancer screening using LDCT to help detect non-small cell lung cancer early, improving health outcomes by including more at-risk individuals.
2. Who is eligible for Medicare coverage of lung cancer screening?
Medicare beneficiaries aged 50-77 with a smoking history of at least 20 pack-years, who are asymptomatic and either current or former smokers, are eligible for LDCT screening.
3. What is the required counseling for lung cancer screening?
Before the screening, patients must receive counseling that includes decision-making on eligibility, the importance of annual screening, and smoking cessation or abstinence advice.
4. What are the requirements for radiologists and facilities performing lung cancer screenings?
Radiologists must be board-certified by the American Board of Radiology or an equivalent, and facilities must use a standardized system for lung nodule identification and reporting.
5. How does CMS’s new policy affect healthcare providers?
The new policy simplifies requirements for counseling, shared decision-making, radiologist eligibility, and imaging facility standards, reducing administrative burdens for providers.
