Part B Insider (Multispecialty) Coding Alert

Published on Mon Feb 16, 2015 PDF

Patients with long history of smoking can now qualify for LDCT.

Although CMS usually saves its new coverage announcements for the first of the year, the agency surprised practices on Feb. 5 when it announced that Medicare would begin covering lung cancer screenings using low dose computed tomography (LDCT) effective immediately.

Medicare patients will be eligible for the lung cancer screening annually if they meet the criteria below:

• Age 55 to 77
• Showing no signs or symptoms of lung cancer
• Either current smokers or quit within the past 15 years
• Tobacco smoking history of at least one pack a day for 30 years
• They have a written order from their provider

Prior to the first screening, the physician and patient should participate in a counseling session discussing the benefits of screening as well as the importance of abstaining from smoking. In addition, if the patient is still smoking, the practitioner must discuss the benefits of smoking cessation counseling with the patient. Some people are calling the screening the equivalent to a “smoker’s mammogram” because of how effective it’s intended to be in catching lung cancer earlier than in the past.

“This is the first time that Medicare has covered lung cancer screening,” said Patrick Conway, MD, CMS’s chief medical officer in a statement. “This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States.”

Many specialty societies applauded the news of the screening. “CMS has taken a bold step that can potentially reduce the lung cancer mortality of patients at highest risk for lung cancer by nearly 20 percent” said Bruce G. Haffty, MD, chair of the American Society for Radiation Oncology in a Feb. 9 statement. “We are grateful for the additional opportunities that annual screening provides us to save hundreds of thousands of lives from lung cancer.”

Resource: To read the complete CMS Decision Memo outlining the requirements for LDCT screening, visit www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274.