Groups Call on CMS to Cover Low Dose CT for Lung Cancer Screening

April 24, 2014

The ACR will urge MedCAC to recommend national Medicare coverage for lung cancer screening.

The American College of Radiology (ACR) will urge the 2014 Medicare Evidence Development and Coverage Advisory Committee (MedCAC) to recommend national Medicare coverage of low dose computed tomography (LDCT) screening for patients at high risk for lung cancer at an April 30 meeting.

The push will come from Ella Kazerooni, MD, chair of the ACR Committee on Lung Cancer Screening. It stems from a December 2013 recommendation by the United States Preventive Services Task Force (USPSTF) to screen asymptomatic adults ages 55 to 80 who have a 30 pack/year smoking history and currently smoke, or have quit within the past 15 years.

The ACR, the Lung Cancer Alliance, the Society of Thoracic Surgeons and 38 other medical organizations want CMS to provide full national coverage for high-risk patients as defined in the USPSTF and provide coverage with evidence for other high-risk patients not included in the USPSTF recommendations using data collected through existing registries, according to a statement by the ACR.

“Lung cancer kills more people each year than breast, colon and prostate cancers combined,” Kazerooni said in a release. “For these other three cancers, there are well established and accepted screening tests and programs. MedCAC should recommend, and CMS should implement, broad national coverage for CT lung cancer screening so that those at high risk can be tested and thousands more people each year can be saved from this terrible disease.”

The Affordable Care Act (ACA) requires that all medical exams or procedures with a grade of B or higher from the USPSTF are covered by private insurers without a co-pay. The ACA does not specify the requirement for Medicare to provide full national coverage for beneficiaries.

Results from National Lung Cancer Screening Trials and those of other controlled trials confirm that CT lung cancer screening significantly reduces lung cancer deaths, the ACR stated. Screening for current former smokers with LDCT is the only method ever proven to reduce lung cancer mortality in this high-risk population, and it has also been shown to be cost effective.

“We strongly urge MedCAC to recommend that the Centers for Medicare & Medicaid Services (CMS) act on the USPSTF recommendation to provide national coverage for high-risk Medicare beneficiaries,” Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors, said in the release. This would support screening programs across the nation, and, for the first time, enable providers and patients to strike back against the nation’s leading cancer killer. It is time for Medicare to support CT lung cancer screening.”

The April 30 meeting can be viewed live here.