{"id":15195,"date":"2022-02-28T19:37:48","date_gmt":"2022-02-28T19:37:48","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15195"},"modified":"2026-01-12T07:22:04","modified_gmt":"2026-01-12T07:22:04","slug":"expanded-coverage-of-lung-cancer-screening-with-ldct","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/expanded-coverage-of-lung-cancer-screening-with-ldct\/","title":{"rendered":"Expanded Coverage of Lung Cancer Screening with LDCT"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On 10<\/span><span style=\"font-weight: 400;\">th<\/span><span style=\"font-weight: 400;\"> Feb 2022, the Centers for Medicare &amp; 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">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. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cExpanding coverage broadens access for lung cancer screening to at-risk populations,\u201d said CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality, Dr. Lee Fleisher.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<h2><strong>Summary of Expanded Coverage<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">The Centers for Medicare &amp; 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:<\/span><\/p>\n<h3><strong>Beneficiary Eligibility Criteria<\/strong><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Age 50 \u2013 77 years; <\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Asymptomatic (no signs or symptoms of lung cancer);<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Current smoker or one who has quit smoking within the last 15 years; and<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Receive an order for lung cancer screening with LDCT.<\/span><\/li>\n<\/ul>\n<h3><strong>Counseling and Shared Decision-Making Visit<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">Before the beneficiary\u2019s 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\u2019s medical records:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Determination of beneficiary eligibility;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Shared decision-making, including the use of one or more decision aids;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">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<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<\/ul>\n<h4 style=\"text-align: center;\"><strong>Our team works behind the scenes to help you understand the insurance and <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/oncology-medical-billing-services.html\">oncology billing process<\/a> so you can focus on your Treatment.<\/strong><\/h4>\n<h3><strong>Reading Lung Cancer Radiologist Eligibility Criteria<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<h3><strong>Lung Cancer Radiology Imaging Facility Eligibility Criteria<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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 <\/span><a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncacal-decision-memo.aspx?proposed=N&amp;ncaid=304\"><span style=\"font-weight: 400;\">CMS website<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><b>Medical Billers and Coders (MBC)<\/b><span style=\"font-weight: 400;\"> is a leading medical billing company providing complete <a href=\"https:\/\/www.medicalbillersandcoders.com\/revenue-management-services.aspx\">revenue cycle management services<\/a>. For provider education, we share the latest billing news and updated billing guidelines in form of articles. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">For the latest medical billing and coding resources, visit our blog page. If you need any help in medical billing and coding for your practice, contact us at <\/span><span style=\"font-weight: 400;\"><a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a>\/<\/span><a href=\"tel:888-357-3226\"><span style=\"font-weight: 400;\"> 888-357-3226<\/span><\/a><\/p>\n<h2><strong>FAQs<\/strong><\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1768202196923\"><strong class=\"schema-faq-question\">1. What is the purpose of the CMS&#8217;s decision on lung cancer screening?<\/strong> <p class=\"schema-faq-answer\">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.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1768202356352\"><strong class=\"schema-faq-question\">2. Who is eligible for Medicare coverage of lung cancer screening?<\/strong> <p class=\"schema-faq-answer\">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.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1768202365955\"><strong class=\"schema-faq-question\">3. What is the required counseling for lung cancer screening?<\/strong> <p class=\"schema-faq-answer\">Before the screening, patients must receive counseling that includes decision-making on eligibility, the importance of annual screening, and smoking cessation or abstinence advice.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1768202373962\"><strong class=\"schema-faq-question\">4. What are the requirements for radiologists and facilities performing lung cancer screenings?<\/strong> <p class=\"schema-faq-answer\">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.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1768202383271\"><strong class=\"schema-faq-question\">5. How does CMS&#8217;s new policy affect healthcare providers?<\/strong> <p class=\"schema-faq-answer\">The new policy simplifies requirements for counseling, shared decision-making, radiologist eligibility, and imaging facility standards, reducing administrative burdens for providers.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>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.\u00a0 On 10th Feb 2022, the Centers for Medicare &amp; Medicaid Services (CMS) announced a national coverage determination [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":15196,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[50,3256,3257,3258,611],"class_list":["post-15195","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-oncology-billing-services","tag-centers-for-medicare-medicaid-services","tag-ldct","tag-lung-cancer-screening-with-ldct","tag-oncology-billing-process","tag-revenue-cycle-management-services"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Expanded Coverage of Lung Cancer Screening with LDCT<\/title>\n<meta name=\"description\" content=\"CMS expands coverage of lung cancer screening with low dose computed ... 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The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/expanded-coverage-of-lung-cancer-screening-with-ldct\\\/#faq-question-1768202196923\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/expanded-coverage-of-lung-cancer-screening-with-ldct\\\/#faq-question-1768202196923\",\"name\":\"1. 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Who is eligible for Medicare coverage of lung cancer screening?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"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.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/expanded-coverage-of-lung-cancer-screening-with-ldct\\\/#faq-question-1768202365955\",\"position\":3,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/expanded-coverage-of-lung-cancer-screening-with-ldct\\\/#faq-question-1768202365955\",\"name\":\"3. 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