Full Medicare Coverage Needed for CT Lung Cancer Screening

March 17, 2014

Medicare should fully cover low-dose CT lung cancer screening as per the USPSTF recommendations for high-risk patients.

National Medicare coverage of low-dose computed tomography (LDCT) screening for patients at high risk for lung cancer needs to be implemented, quickly, say several medical organizations, including the American College of Radiology (ACR).

Medical and patient groups are requesting that The Centers for Medicare & Medicaid Services (CMS) provide full national coverage for high-risk patients following the December 2013 release of the United States Preventive Services Task Force (USPSTF) B recommendation, which stated that screening should be done on adults ages 55 to 80 who have a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years.

“Lung cancer kills more people each year than breast, colon and prostate cancers combined,” Douglas E. Wood, MD, immediate past president of The Society of Thoracic Surgeons said in a release. “For each of these other three cancers, there are well established screening tests and programs.”

Implementing broad national coverage of lung cancer screening for those at high risk can provide the opportunity to save thousands of people each year, Wood said in the release.  

Once patients have gone longer than 15 years without smoking, the screening is no longer recommended. Screening is also not recommended if the patients have a health problem that substantially limits life expectancy, according to the USPSTF recommendations.

The Affordable Healthcare Act does not specify that Medicare should provide full national coverage for medical exams or procedures that receive a grade “B” or higher from the USPSTF, although coverage is required by private insurers.

“The USPSTF’s recommendation that made lung cancer screening an essential health benefit specifically included 65 to 80 year olds who are also part of the Medicare population,” Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, said in a release. “If Medicare does not extend full coverage for lung cancer screening to this population, the net effect will be a two-tier system that leaves Medicare beneficiaries at greater risk of dying from lung cancer than those with private insurance.”