The Centers for Medicare & Medicaid Services (CMS) has proposed that the evidence is sufficient to add lung cancer screening with low dose computed tomography (LDCT), once per year, as an additional preventive service benefit under the Medicare program, when specified criteria are met.
As a preventive services benefit under Medicare, the decision allows a patient to enter a CT screening program after undergoing a mandatory lung cancer screening counseling and shared decision-making visit with his or her physician. Screening is already included for eligible individuals in private health plans under terms of the U.S. Affordable Care Act (ACA).
To be eligible, beneficiaries, radiologists and imaging centers must meet the following criteria:
Beneficiary eligibility criteria:
- Age 55-74 years;
- Tobacco smoking history of at least 30 pack-years
- Current smoker or one who has quit smoking within the last 15 years
- A written order for LDCT lung cancer screening that meets the criteria
- A lung cancer screening counseling and shared decision making visit
Radiologist eligibility criteria:
- Hold a current certification with the ABR or equivalent organization
- Documented training in diagnostic radiology and radiation safety
- Provided supervision and interpretation of at least 300 chest CT’s in the past 3 years
- Documented CME in accordance with current ACR standards.
Imaging center eligibility criteria:
- Has participated in past lung cancer screening trials or is an accredited advanced diagnostic imaging center with experience in LDCT lung cancer screening
- Must use LDCTs with an effective radiation dose less than 1.5 mSv
- Must collect and submit data to a CMS-approved national registry for each LDCT.
ADVOCATE will continue to provide updates as information becomes available.
Kirk Reinitz, CPA