2015

Home ▶ Washington Letter ▶ 2015 ▶ CMS Issues Final CT Lung Cancer Screening Coverage Policy
CMS Issues Final CT Lung Cancer Screening Coverage Policy

February 2015

Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued the final Medicare coverage policy for CT lung cancer screening under Medicare. The final policy covers annual low dose CT lung cancer scans for Medicare beneficiaries who 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 (as defined in Section 1861(r)(1) of the Social Security Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Social Security 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 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 (as defined in Section 1861(r)(1) of the Social Security Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the Social Security Act).  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

The ATS, through the Thoracic Oncology Assembly, played a key role in advocating with CMS for this policy.  The ATS worked closely with sister organizations and with CMS to draft both the proposed and final coverage policy.  The ATS is pleased that most of our recommendations were incorporated by CMS into the final policy.

The U.S. Preventive Services Taskforce recently gave CT lung cancer screening a "B" grade. Under the Affordable Care Act, all preventative services that receive an "A" or "B" grade from the U.S. Preventive Services Taskforce must be covered by private insurance with no copays for beneficiaries. The recently announced Medicare coverage policy will compliment lung cancer policy that is being adopted by private insurers.

The ATS believes this new coverage policy will significantly advance early detection and treatment of lung cancer in the U.S. If you have questions about how to use the new coverage policy, please contact the ATS at codingquestions@thoracic.org.

Last Reviewed: October 2017