Medicare to Cover LDCT Lung Cancer Screening

Medicare to Cover LDCT Lung Cancer Screening

The Centers for Medicare & Medicaid Services (CMS) has determined that lung cancer is a big enough health threat to its senior beneficiaries to warrant coverage for a screening counseling and shared decision-making visits. Certain beneficiaries may qualify for coverage of annual screenings for lung cancer with low dose computed tomography (LDCT), as well.

To qualify for annual screenings, a beneficiary must meet the following criteria:

  • Age 55 – 77 years;
  • Asymptomatic (no signs or symptoms of lung cancer);
  • Tobacco smoking history of at least 30 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
  • Receives a written order for LDCT lung cancer screening that meets the following criteria:
    • For the initial LDCT lung cancer screening service:  A beneficiary must receive a written order for LDCT lung cancer screening during a lung cancer screening counseling and shared decision-making visit, furnished by a physician or qualified non-physician practitioner. A lung cancer screening counseling and shared decision-making visit includes the following elements (and is appropriately documented in the beneficiary’s medical records):
      • Determination of beneficiary eligibility including age, absence of signs or symptoms of lung cancer, a specific calculation of cigarette smoking pack-years; and if a former smoker, the number of years since quitting;
      • Shared decision-making, including the use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure;
      • Counseling on the importance of adherence to annual lung cancer LDCT screening, impact of comorbidities and ability or willingness to undergo diagnosis and treatment;
      • Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions; and
      • If appropriate, the furnishing of a written order for lung cancer screening with LDCT.
    • For subsequent LDCT lung cancer screenings: The beneficiary must receive a written order for LDCT lung cancer screening, which may be furnished during any appropriate visit with a physician or qualified non-physician practitioner. If a physician or qualified non-physician practitioner elects to provide a lung cancer screening counseling and shared decision-making visit for subsequent lung cancer screenings with LDCT, the visit must meet the criteria described above for a counseling and shared decision-making visit.
    • Written orders for both initial and subsequent LDCT lung cancer screenings must contain the following information, which must also be appropriately documented in the beneficiary’s medical records:
      • Beneficiary date of birth;
      • Actual pack – year smoking history (number);
      • Current smoking status, and for former smokers, the number of years since quitting smoking;
      • Statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer); and
      • National Provider Identifier (NPI) of the ordering practitioner.

LDCT screening must be performed at an eligible radiology imaging facility and read by an eligible radiologist. See the decision memo (CAG-00439N) for imaging criteria.

The decision memo, posted February 5, does not specify a date for when this coverage goes into effect. According to Reuters, the coverage is effective immediately and applies nationwide. Consult your Medicare administrative contractor for specific coverage.

Source: Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N)

dec-clearance-sale

Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

Latest posts by Renee Dustman (see all)

About Has 428 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

2 Responses to “Medicare to Cover LDCT Lung Cancer Screening”

  1. Carol Kudlak says:

    This is a huge step toward keeping medical costs down for the Federal Government!! I am so glad to hear that HHS – Centers for Medicare and Medicaid will begin to cover screening tests for high risk patients so beneficiaries will receive quality of care early enough that the costs will be low. Hooray!!

  2. Bridget says:

    This new regulation leaves out another item worth screening:
    Those of us who have not smoked but lived with a heavy smoker for years (who refused to smoke outside) and therefore have been exposed to years of heavy second-hand smoke!!!
    >>According to the 2014 Surgeon General’s Report, there have been more than 20 million smoking-related deaths in the United States since 1964; 2.5 million of those deaths were among non-smokers who died from exposure to secondhand smoke. During that same time, 100,000 babies have died due to parental smoking (including smoking during pregnancy).[http://www.cancer.org/cancer/cancercauses/tobaccocancer/secondhand-smoke]

Leave a Reply

Your email address will not be published. Required fields are marked *