Medicare Coverage for Lung Cancer Screening Frequently Asked Questions
On February 5, 2015, the Centers for Medicare and Medicaid Services (Medicare) issued its final decision about coverage of low-dose CT (LDCT) lung cancer screening. Coverage begins immediately.
Below are some of the frequently asked questions about Medicare's recent announcement:
Which Medicare patients are eligible for lung cancer screening under this proposal?
Medicare has decided that there is sufficient evidence to cover annual LDCT lung cancer screening coverage among Medicare beneficiaries considered high risk.2
- Age 55-77 years
- No current signs or symptoms of lung cancer
- Tobacco smoking history of at least 30 pack-years (pack-years are calculated by multiplying the number of packs smoked per day by number of years smoked)
- Current or former smokers who have quit within the last 15 years
What must physicians do so that their Medicare patients can be screened for lung cancer?
Physicians must provide a written order for screening to Medicare after having a lung cancer screening counseling and shared decision making visit with patient. This visit includes:
- Confirmation that patients meet the high risk definition
- A discussion with the Medicare patient regarding the benefits and harms of screening; information regarding follow-up to the screening; the risks of over-diagnosis and radiation exposure; and a warning that a false positive diagnosis could occur
- Counseling on the importance of being screened each year and the impact of other possible causes of death with lung cancer
- Counseling on the importance of quitting smoking, or staying quit, including information on Medicare-covered cessation services
What must radiologists do to be able to perform lung cancer screenings?
Medicare wants to make sure qualified, experienced radiologists are serving Medicare patients. As a result, Medicare required that any radiologist involved with lung cancer screening for Medicare patients:
- Be certified or eligible to be certified with the American Board of Radiology or an equivalent organization
- Have documented training in diagnostic radiology and radiation safety
- Have significant recent (within the past 3-years) experience in reading and interpreting CT scans for possible lung cancer
- Participate in continuing medical education in accordance with American College of Radiology standards
- Furnish lung cancer screening with LDCT in a radiology imaging facility that meets the radiology imaging facility eligibility
Where can Medicare patients be screened for lung cancer?
To be an eligible screening facility, a site must have:
- Use the proper level low-dose CT scans
- Use a standardized lung nodule identification, classification and reporting system
- Make available smoking cessation interventions for current smokers
- Collect and submit certain patient data to a Medicare-approved data registry for each lung cancer screening test performed, including patient demographics, the exam results, the follow-up procedures and the ultimate patient health outcomes
When does this new coverage start?
This coverage is effective immediately, February 6, 2015.
Can patients who are not enrolled in Medicare receive lung cancer screening?
On December 30, 2010 the U.S. Preventive Services Task Force (USPSTF) issued a new 'B' recommendation for lung cancer screenings for those at high risk. The USPSTF recommendation makes lung cancer screening with these same low-dose CT scans required coverage in many private or employer-sponsored health insurance plans starting in 2015.3 High-risk patients who do not have Medicare should check with their health insurance plan to see whether screening for lung cancer is covered.
Approved by Scientific and Medical Editorial Review Panel. Last reviewed November 3, 2016.