From the Guidelines
Medicare covers lung cancer screening with low-dose computed tomography (LDCT) once per year for individuals who meet specific criteria, including being between 55 and 77 years old, having a tobacco smoking history of at least 30 pack-years, and being a current smoker or having quit within the last 15 years. To qualify, individuals must also have no signs or symptoms of lung cancer and undergo a lung cancer screening counseling and shared decision-making visit with a qualified medical provider, as required by the Centers for Medicare and Medicaid Services (CMS) 1. This visit must include a discussion of the benefits and harms of LDCT screening, including false positives and unnecessary procedures, as well as the importance of adherence to screening and follow-up testing 1.
The criteria for Medicare coverage of lung cancer screening are as follows:
- Age: 55-77 years old
- Smoking history: at least 30 pack-years, with tobacco use within the prior 15 years
- Comorbid conditions: no conditions that substantially limit life expectancy
- Symptoms: no symptoms suggestive of lung cancer
- Shared decision making: required, including a discussion of benefits, harms, follow-up testing, and importance of adherence
- Radiologist eligibility: current certification with American Board of Radiology (or equivalent) and training in diagnostic radiology and radiation safety
- Screening facility eligibility: accredited advanced diagnostic imaging center with training and experience in LDCT screening
It is essential to note that the CMS coverage determination requires a prescreening visit with a qualified medical provider to confirm eligibility and to engage in counseling and shared clinical decision making 1. This requirement reflects the importance of informed decision making and patient-centered care in lung cancer screening. By prioritizing shared decision making and patient education, healthcare providers can ensure that individuals make informed decisions about their care and receive high-quality, patient-centered care 1.
From the Research
Criteria for Medicare to Cover Lung Cancer Screening
The criteria for Medicare to cover lung cancer screening with low-dose computed tomography (LDCT) are as follows:
- Age: 55 to 77 years 2
- Smoking history: ≥ 30-pack-year smoking history 2
- Current smoking status: current smoker or quit in the last 15 years 2
Key Points
- Medicare covers LDCT screening for high-risk beneficiaries 2
- The screening is expected to reduce lung cancer mortality and increase early diagnosis 3, 2
- However, there are concerns about false-positive findings, overdiagnosis, and the overall costs of follow-up tests and procedures 3, 4, 5
Screening Frequency and Duration
- The frequency and duration of screening are not explicitly stated in the provided evidence, but it is mentioned that annual or biennial screening may be used 5
- The duration of screening can range from 1 year to 10 years 5