Medicare lung cancer screening coverage should be updated to reflect new U.S. Preventive Services Task Force (USPSTF) eligibility thresholds and remove barriers that keep at-risk populations from accessing these lifesaving exams.
That is the message in a letter from the American College of Radiology (ACR), the GO2 Foundation for Lung Cancer and The Society of Thoracic Surgeons (STS), urging the Centers for Medicare & Medicaid Services (CMS) to open a National Coverage Determination (NCD) reconsideration on lung cancer screening.
“We are committed to saving lives through improved access to screening. The USPSTF has expanded the screening population—particularly among the most vulnerable and underserved. Now we urge Medicare to move quickly to cover these Americans and make changes to improve access and make the screening process less complex. This joint ‘call to action’ reinforces that these steps will help save lives,” says Laurie Fenton Ambrose, president and CEO of the GO2 Foundation for Lung Cancer.
Specifically, the groups want CMS to:
- Revise and lower the screening eligibility age to 50 years and smoking history criteria to 20 pack-years in the Medicare population.
- Revise the following key areas to safeguard against barriers in lung cancer screening uptake in the Medicare population.
- Eliminate the following annual screening eligibility criteria to mirror the National Comprehensive Cancer Network (NCCN) guidelines: Current smoker or one who has quit smoking within the past 15 years and the upper age limit of 77 years.
- Revise the “Counseling and Shared Decision Making” NCD criteria to ensure the current language and requirements do not act as barriers to screening uptake.
- Formally instruct all Medicare Administrative Contractors to cover/reimburse low-dose CT performed in all facilities, including independent diagnostic testing facilities.
“Aligning Medicare and private insurance coverage and making these exams more accessible to those who need them can make low-dose CT scans the most successful cancer screening test in history,” says Sean C. Grondin, MD, MPH, FRCSC, president of the Society of Thoracic Surgeons. “However, even this cost-effective test can’t help medical professionals save lives if the people who need these exams can’t access them. Medicare and private insurers should extend coverage now.”
Debra Dyer, MD, FACR, chair of the ACR Lung Cancer Screening Steering Committee, adds: “Lack of coverage for those who need it has contributed to a severe underuse of lung cancer screening—which has undoubtedly cost lives. Swift coverage expansion by Medicare and private insurers would help doctors and allied professionals address racial and regional disparities and strike back against the nation’s leading cancer killer by using lung cancer screening to its full advantage.”
