Expanded Access to CT Lung Cancer Screening in Medicare

The ACR is actively working with Congress and CMS to ensure that Medicare preserves patient access to and proper reimbursement for CT lung cancer screening for patients at high-risk of developing lung cancer.

Thanks to the tremendous advocacy efforts of the College’s physician leadership, members, and coalition partners working in conjunction with ACR Government Relations and Economics offices, on February 5, 2015, CMS released a final NCD which found that the evidence is sufficient to permit high-risk patients to receive annual LDCT scans without cost sharing.

High-risk patients were defined as individuals between the ages of 55 and 77 who smoked at least one pack of cigarettes every day for 30 years or ceased tobacco use within the last 15 years. The final NCD also outlined reasonable patient shared decision-making guidelines, as well as minimum quality standards and requirements which both imaging centers and radiologists must meet should they want to provide or interpret LDCT scans.

Issue Background


Advances in science and technology are making early lung cancer screening more effective. Providing patients at high-risk of developing lung cancer with annual low-dose CT (LDCT) scans has enabled radiologists to accurately diagnose and treat early stage lung cancer and, subsequently, save more lives.

The findings of the National Lung Screening Trial (NLST), a randomized control trial of more than 53,000 high-risk patients between the ages of 55 and 74, provide indisputable empirical evidence of the benefits of screening patients with this advanced imaging modality.

NLST data found that patients receiving annual CT screens had a 20 percent lower lung cancer mortality rate in comparison to individuals screened using standard radiography. NLST data also proves that annual LDCT scans are more cost effective than other accepted cancer screening interventions, including breast, cervical, and colorectal cancer screenings.

Timeline


In December 2013 the United States Preventive Services Task Force (USPSTF) assigned a Grade of “B” to annual LDCT scans for patients between the ages 55 and 80 who are current smokers with at least 30 pack years of smoking history or former smokers who ceased tobacco use within the last 15 years.

Per the provisions of the Patient Protection and Affordable Care Act (PPACA), starting in 2015 private insurance companies participating in the health insurance exchanges must provide all preventive services with a USPSTF Grade of “B” or higher to patients without cost sharing. Although PPACA mandates that privately insured individuals receive this life saving screening service, these same coverage requirement provisions do not extend to Medicare, and prior to February 2015, it was unclear whether patients 65 and older will have equal access to this same benefit. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 gave Medicare the power, but not the requirement, to add new preventive services if the USPSTF assigns these procedures a grade of “B” or higher.

The Task Force’s revised grade on LDCT prompted the Centers for Medicare and Medicaid Services (CMS) to initiate a National Coverage Determination (NCD) process to assess whether Medicare will fully cover this screening exam. Under the NCD process, Medicare solicited stakeholder feedback, reviewed published scientific evidence on the issue, and convened a formal Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) hearing on April 30, 2014. A proposed NCD was released by CMS in November 2014, followed by a final decision regarding LDCT lung cancer screening on February 8, 2015. Despite the favorable February 2015 NCD, it took many (6+) months to place instructions to Medicare contractors before patients 65 and older actually started receiving the procedure.

Lung Cancer Screening in 2017 HOPPS


Lung Cancer Screening Resources

LCSResources_320

The ACR is your best resource for safe, effective lung cancer screening with the latest research, toolkits and key patient information.

Access Now

RAN

RAN_320

Join members across the country who are ensuring that radiology's voice is heard at the local and federal levels.

Get involved today