CMS to Begin Covering Preventative CT Scans for Eligible Smokers

On November 10, 2014, The Centers for Medicare & Medicaid Services (CMS) issued a Proposed Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT).[1]  Under the new, proposed framework, Medicare beneficiaries who have a qualifying tobacco history of smoking at least one pack of cigarettes per day for thirty years would be eligible to receive an annual, preventative lung cancer CT screening.  The CT scan would be provided free-of-charge to Medicare beneficiaries between the ages of 55 and 74 who are either current smokers or recent smokers, having met the above qualifying tobacco history within the past fifteen years.  Pursuant to the CMS proposal, all covered scans must be performed at eligible facilities which have participated in past lung cancer screening trials, or in accredited advanced diagnostic imaging centers with training and experience in LDCT lung cancer screening.

While the Affordable Care Act already requires private insurers to cover preventative CT scans for long-term smokers at heightened risk for lung cancer, this CMS proposal would extend that coverage to a heavily-hit, previously-uncovered market: Medicare beneficiaries.   The initial written order for a preventative CT screening must be made during a formalized lung cancer screening, counseling, and shared decision making visit, and must be documented in a form prescribed by CMS.  Subsequent annual screenings can be ordered in writing as part of a qualifying patient’s annual wellness exam, with certain documentation requirements.

This CMS decision, which will likely become effective in February, comes at the behest of industry trends recognizing the importance and feasibility of early lung cancer detection, treatment, and prevention, as well as formal requests from a number of national cancer specialists.

[1] A copy of the CMS Proposal, as well as a detailed criteria for applicability is available at: http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=274

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