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 began immediately.
Below are some of the frequently asked questions about Medicare coverage for lung cancer screening:
Medicare has decided that there is sufficient evidence to cover annual low-dose CT lung cancer screening coverage among Medicare beneficiaries considered high risk.
- 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
Physicians must provide a written order for screening to Medicare after having a lung cancer screening counseling and a shared-decision making discussion with the 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
Medicare wants to make sure qualified, experienced radiologists are serving Medicare patients. As a result, Medicare requires that any radiologist involved with lung cancer screening for Medicare patients:
- Be certified or eligible to be certified by 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
To be an eligible screening facility, a site must:
- 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
This coverage began on Feb. 6, 2015.
Many private health insurance plans cover lung cancer screening without cost-sharing, but eligibility criteria varies based on type of plan you have and many plans are currently updating their criteria to match new guidelines. Check out our coverage chart to learn more.
On March 9, 2021, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation for lung cancer screening for those at high risk – individuals who between the ages of 50 and 80, have a 20 pack-year history of smoking, and are a current smoker or have quit within the past 15 years. Medicare has not yet changed its eligibility criteria, but the Lung Association is advocating for Medicare to do so as soon as possible.
Page last updated: March 17, 2021