2014

HomeWashington Letter2014 ▶ CMS Announces Proposed Coverage Policy for Lung Cancer Screening
CMS Announces Proposed Coverage Policy for Lung Cancer Screening

November 2014

This week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed coverage policy for lung cancer screening. The ATS is very pleased that our coordinated efforts with sister organizations were successful in helping CMS reach this decision. While CMS did not adopt every recommendation provided by the ATS, the proposed coverage policy is a welcome step forward in making this proven screening service available to Medicare beneficiaries.

The proposed policy would add Medicare benefits of a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, screening for lung cancer with low dose computed tomography (LDCT), once per year, as an additional preventive service benefit. The proposed criteria for qualifying for this benefit are:

Patient Beneficiary Criteria:

  • Age 55-74 years;
  • Asymptomatic (no signs or symptoms of lung disease);
  • 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
  • A written order for LDCT lung cancer screening that meets the following criteria:
    • For the initial LDCT lung cancer screening service: the 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 [as defined in Section 1861(r)(1) of the Social Security Act (the Act)] or qualified non-physician practitioner (physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act).
    • For subsequent LDCT lung cancer screenings: the beneficiary must receive a written order, which may be furnished during any appropriate visit (for example: during the Medicare annual wellness visit, tobacco cessation counseling services, or evaluation and management visit) with a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the Act).
  • 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 disease, 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, harms, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure;
    • Counseling on the importance of adherence to annual LDCT lung cancer 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 smoking cessation if current smoker and, if appropriate, offering additional Medicare-covered tobacco cessation counseling services; and
    • If appropriate, the furnishing of a written order for lung cancer screening with LDCT. Written orders for both initial and subsequent LDCT lung cancer screenings must contain the following information, which must also be documented in the beneficiaries' 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; and
      • NPI of the ordering practitioner.

The complete proposed policy can be found here.

The public comment period on the proposed coverage decision closes12/10/2014. The ATS, in coordination with ATS Thoracic Oncology Assembly, will be submitting comments to CMS.

Last Reviewed: October 2017