Medicare proposes coverage for low-dose CT screening for those at high risk for lung cancer

In a long-awaited decision, the Centers for Medicare & Medicaid Services (CMS) issued a draft proposal that extended coverage of annual low-dose CT screening to Medicare beneficiaries at high risk for lung cancer.

Beneficiaries who are 55 to 74 years of age with a 30-pack-year smoking history who currently smoke or quit within the past 15 years would be eligible. CMS also included a number of requirements for screening facilities and physicians in the proposal.

While a number of prominent organizations, including the American College of Radiology (ACR) and the American Lung Association, backed the decision, it comes as somewhat of a surprise considering a Medicare advisory committee earlier this year gave a vote of low confidence to the question of whether enough evidence existed to prove the benefits of such screening in a Medicare-aged population.

“CT lung cancer screening is the first and only cost-effective test proven to significantly reduce lung cancer deaths. Medicare coverage provides access to care for seniors and will help physicians save thousands of lives each year from the nation’s leading cancer killer,” said Ella Kazerooni, MD, FACR, chair of the ACR Lung Cancer Screening Committee and ACR Thoracic Imaging Panel, in a statement.

The fine print

Under the proposal, Medicare will require facilities performing the screening to submit data on findings and follow-up to approved registries. The ACR announced it will apply to be such a registry.

Radiologists interpreting the scans must have significant experience reading CT scans for possible lung cancer, and CMS is also requiring that screening take place in a center with extensive experience or is accredited as an advanced diagnostic imaging center. Radiation doses are capped as well, with a requirement that scans deliver 1.5 mSv or less of radiation.

Patients must undergo counseling and shared decision making with their physician in order to discuss the benefits and harms of screening, smoking cessation and other important topics.

“The American Lung Association applauds Medicare for this lifesaving announcement,” said Harold P. Wimmer, national president and CEO of the American Lung Association. “Today’s proposal by Medicare will save lives, increasing the low survival rates associated with lung cancer, our nation’s leading cancer killer.”

CMS will collect public comments in response to the draft proposal until Dec. 10. A final decision is expected in February 2015.

You can view the draft proposal here.