CMS Expands Eligibility Criteria for Lung Cancer Screening With Low-Dose Computed Tomography
More Medicare beneficiaries now meet age, smoking history, and other criteria for lung cancer screening and are now eligible to receive low-dose computed tomography (LDCT), according to a February 2022 memo (https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304) from the Centers for Medicare and Medicaid Services (CMS).
CMS said (https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304) it reconsidered the national coverage determination and found sufficient evidence to support expansion of eligibility criteria for Medicare beneficiaries to receive LDCT, a recommended (https://www.cdc.gov/cancer/lung/basic_info/screening.htm) screening test for individuals who have a high risk of developing lung cancer based on their age and smoking history.
The revised beneficiary eligibility criteria are (https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304):
- Aged 50–70 years
- No signs or symptoms of lung cancer
- Tobacco smoking history of at least 20 pack-years
- Current smoker or one who has quit smoking in the past 15 years
- Receive an order for lung cancer screening with LDCT
CMS also said (https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304) that to qualify, the beneficiary must receive counseling and a shared decision-making visit to discuss beneficiary eligibility, adherence to annual LDCT screening and impact of comorbidities, and maintaining cigarette smoking abstinence and smoking cessation. Screening must also be furnished in a radiology imaging facility that uses a standardized lung nodule identification, classification, and reporting system.
“The policy simplifies requirements for the counseling and shared decision-making visit, removes the restriction that it must be furnished by a physician or non-physician practitioner, reduces the eligibility criteria for the reading radiologist, and reduces the radiology imaging facility eligibility criteria,” CMS said (https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304).