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.
On Dec. 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. High-risk patients who do not have Medicare should check with their health insurance plan to see whether screening for lung cancer is covered.
Page last updated: April 14, 2020