Medicare Should Not Cover CT Screening for Lung Cancer, Panel Says

May 1, 2014

MEDCAC decided yesterday that there was not enough evidence to make the recommendation.

Medicare should not cover annual screening of lung cancer with low dose computed tomography (CT) in high risk individuals, according to the Medicare Evidence & Coverage Advisory Committee (MEDCAC).

The nine member panel, which is made up of health professionals and clinicians, decided yesterday after a day’s deliberation and was asked to vote on a scale of whether they were confident that the benefits of the screening would outweigh the harms in the Medicare population. The mean score of the vote, which was on a scale of one to five, was a two, which represents low to intermediate confidence.

The panel’s vote was based on a lack of evidence to justify the annual CT scans. This comes despite the December 2013 U.S. Preventive Services Task Force (USPSTF) recommendation that current or past heavy smokers ages 55 to 80 should receive the scans. The USPSTF recommendation stemmed from results from the National Lung Screening Trial (NLST), which found a 20 percent reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those using chest X-rays.

The panel determined that the risks of the screening, such as potential for overdiagnosis and a high frequency of false-positive results, which result in additional workup, patient anxiety and unnecessary treatment, outweighed the benefits, according to news reports.

The Affordable Care Act (ACA) requires that private insurers cover all medical exams or procedures that receive a grade of “B” or higher from the USPSTF without a co-pay. The ACA does not specify that Medicare provide the same coverage.

Of the more than 40 medical societies that petitioned the CMS to provide the screening expressing disappointment about the vote is the American College of Radiology (ACR).

“Lack of national Medicare coverage for CT lung cancer screening places many Medicare beneficiaries at a potentially lethal disadvantage to those covered by private insurance regarding lung cancer survival,” the ACR stated in a release.

“Without national Medicare coverage for CT lung cancer screening, seniors face a two-tier coverage system in which those with private insurance will be covered for these exams and many of their lives saved, while Medicare beneficiaries are left with lesser access to these exams and placed at increased risk of dying from lung cancer. CMS needs to move for full national coverage as the USPSTF recommendations would indicate,” Ella Kazerooni, MD, chair of the American College of Radiology Lung Cancer Screening Committee, said in a release.  

CMS is expected to issue a proposed decision on the issue by November 2014, with a final decision in February 2015.