On February 10, 2022, the Centers for Medicare and Medicaid Services (Medicare) updated their coverage determination of low-dose CT (LDCT) lung cancer screening. Coverage began immediately. This policy has significantly expanded who can access lung cancer screening with Medicare.
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 who fit the following criteria:
- Age 50-77 years
- No current signs or symptoms of lung cancer
- Tobacco smoking history of at least 20 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 an 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
Previously, low-dose CT lung cancer screenings were only covered for Medicare patients aged 55-77 with at least a 30 pack-year smoking history who currently smoke or have quit within the last 15 years. Based on a updated review of the evidence on lung cancer screening, Medicare expanded the eligibility criteria, allowing more patients who are considered to be at high-risk for lung cancer to have access to this lifesaving screening.
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
- To search for LDCT screening sites, you can visit https://www.acr.org/Clinical-Resources/Lung-Cancer-Screening-Resources/LCS-Locator-Tool.
The expanded coverage began on Feb. 10, 2022.
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.