Medicare to Cover Annual CT Scan for Individuals at High Risk for Lung Cancer
American Lung Association Applauds Final Coverage Announcement
(February 5, 2015) - Chicago, IL
The Centers for Medicare and Medicaid Services (Medicare) announced today its final coverage determination for an annual low-dose computed tomography (CT) scan regarding lung cancer. The American Lung Association applauds Medicare for finalizing its coverage determination and looks forward to working to educate everyone at high risk for lung cancer that coverage is available.
Medicare beneficiaries at high risk for developing lung cancer will have coverage for low-dose CT scans. Medicare defined high risk as individuals 55 to 77 years of age, who have a smoking history of smoking up to 30 pack-years (equivalent of one pack of cigarettes a day for 30 years), who have quit smoking within the last 15 years and have no signs or symptoms of lung cancer.
"Today Medicare announced action that will save lives and increase the low survival rates associated with lung cancer, our nation's leading cancer killer," said Harold P. Wimmer, National President and CEO of the American Lung Association.
Consistent with its original proposal, Medicare will require facilities performing CT scans to submit data including initial screening findings, follow-up and the patient's ultimate health outcomes. Medicare will also require that radiologists serving Medicare patients have significant experience in reading and interpreting CT scans for possible lung cancer.
The Lung Association also applauds Medicare for requiring providers to include smoking cessation counseling or counseling about the importance of quitting tobacco for life as one of the elements leading up to the annual scan.
In December 2013, the U.S. Preventive Services Task Force (USPSTF) awarded a "B" grade to annual low-dose CT screening for individuals at high risk for lung cancer. Under the Affordable Care Act, effective prevention measures—graded "A" or "B"—are included in the Essential Health Benefit. Individuals who are enrolled in state health marketplace plans, enrolled in Medicaid-expansion programs and those with non-grandfathered private insurance plans who meet the screening criteria will have insurance coverage for screening without co-payments or other barriers starting January 1, 2015 or the beginning of their next plan year. The American Lung Association has created a chart to help explain this coverage, which will be updated to incorporate the new Medicare screening criteria.
Lung cancer is the leading cause of cancer death for both men and women in the United States. The five-year survival rate for lung cancer patients is only 16.6 percent. An annual low-dose CT scan for individuals at high risk has the potential to dramatically improve lung cancer survival rates by finding the disease at an earlier, more treatable stage. The USPSTF estimates that if everyone who is at high risk is screened, there will be a 14 percent reduction in lung cancer deaths in the United States.
The most important risk factor for lung cancer is smoking, and the best thing people can do to reduce their risk is to stop smoking or never start. The American Lung Association has helped more than one million people quit smoking through its Freedom From Smoking® program and its Lung HelpLine at 1-800-LUNGUSA. Information on lung cancer screening, education and support and other lung cancer risk factors including exposure to secondhand smoke, radon, air pollution and other hazardous materials, can be found on the American Lung Association's website Lung.org.
In 2014, the American Lung Association launched LUNG FORCE, our national movement focused on fighting lung cancer in women. Despite being the #1 cancer killer of women, only one percent of women say it's on their radar, according to our inaugural Women's Lung Health Barometer. LUNG FORCE is seeking to right this wrong: it's about education, about uniting women to make a difference and inspiring America to take action against the devastating disease that is lung cancer.
The American Lung Association will conduct a thorough analysis of Medicare's final National Coverage Determination and will have further information available on our website at Lung.org/lcscreening.