In February 2015, a long process of review and evaluation of low-dose CT scans for lung cancer screening concluded when the Centers for Medicare & Medicare Services decided to cover the scans for Medicare beneficiaries who are heavy smokers.
Medicare will cover LDCT lung cancer screening once per year for beneficiaries who meet all of the following criteria:
- Age 55-77 and are either current smokers or have quit smoking within the last 15 years
- Smoked for at least 30 “pack years” (an average of one pack a day for 30 years)
- Received a written order from a physician or qualified non-physician practitioner that meets certain requirements.
CMS also set additional requirements: Screening is allowed only once per year and requires a doctor's order. The patient must also undergo "shared decisionmaking" counseling in which a medical professional explains screening benefits and harms. In addition, screening facilities must submit scan data to a registry approved by CMS. The agency also set the billing codes and payment levels for low-dose CT for cancer screening and counseling.
Two of the important factors leading up to the decision was a clinical study by the National Institute of Health and a recommendation in favor of screening by a key federal health task force.
- United States Preventive Services Task Force (USPSTF)
- In December, 2013, the USPSTF recommended annual low-dose CT screening for people between 55 and 80 years of age who are at high risk for lung cancer because they are heavy smokers or were previously, but quit within the past 15 years. The recommendation was based on a comprehensive review of the available evidence, including results of the 2011 NIH National Lung Screening Trial. The task force found that low-dose CT scans more accurately identify early stage lung cancer than do other screening tests. The group also found that many lung cancer deaths can be prevented by screening high-risk people every year.
- NIH National Lung Cancer Screening Trial
- In 2011, the National Institutes of Health reported the results of its long-term, randomized controlled clinical trial which found that LDCT led to a 20% relative reduction in mortality from lung cancer. The authors of the study, which began in 2002 and enrolled more than 50,000 patients, concluded that “screening with the use of low-dose CT reduces mortality from lung cancer.”