Medicare Panel Rescinds Annual CTs for Heavy Smokers

The Medicare Evidence Development and Coverage Committee voted in April that it can’t justify paying for annual computed tomography (CT) scans for early lung cancer detection in heavy smokers.

According to Modern Healthcare, the committee indicated to the Centers for Medicare & Medicaid Services (CMS) “that they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.”

The committee’s decision is a non-binding counter act to the U.S. Preventive Services Task Force’s December 2013 recommendation that heavy smokers (ex-smokers and current) 55 to 80 years of age should be covered for yearly scans, costing insurers typically $300 to $400 for each CT scan.

The USPSTF’s decision was based on the National Lung Screening Trial, “which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays,” according to Modern Healthcare.

Medicare Evidence Development and Coverage Committee, composed mostly of clinicians, concluded the National Lung Screening Trial did not have enough evidence to recommend a new coverage policy to CMS, and more studies should be conducted.

A proposed decision is expected from CMS in November, with a national coverage determination by February 2015.

Source: ModernHealthcare.com, Virgil Dickson, “CMS should not pay for regular CT screenings for heavy smokers, panel says”

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Michelle Dick
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Michelle Dick

Executive Editor at AAPC
Michelle A. Dick has been executive editor for AAPC for over seven years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. Dick has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.
Michelle Dick
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Michelle A. Dick has been executive editor for AAPC for over seven years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. Dick has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

One Response to “Medicare Panel Rescinds Annual CTs for Heavy Smokers”

  1. A. Burrows says:

    I agree with the basic premiss of this action but with the reservation that a combined cost share system be set up for a every 2nd year scan to offset consumer cost as well a lower the cost to Medicare .
    This could still save lives and catch at an early onset a cancer upswing for a patient rather than totaly ignor or prohibit scans reasonable to cover these heavy current or former smokers. Truly, younger current heavy smokers should now have the fullest information about the danger they are puting themselves into and therefore may also be put into a longer reserve scan bases that would be done only once every 5 years as they are not concerned with their own protection by continued heavy smoking habits and limitting the use of high cost scans to these people would keep costs down.

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