In February 2022, the Centers for Medicare and Medicaid Services (CMS) finalized significant modifications to its National Coverage Determination (NCD): Screening for Lung Cancer with Low Dose Computed Tomography (LDCT), In doing so, CMS liberalized the NCD and created broader eligibility in order to enhance access to the screening benefit to eligible individuals.
To facilitate the implementation of the new NCD, CMS has just released a new "MLN Matters" article, and two new transmittals, here and here.
Effective for claims with dates of service on or after February 10, 2022, CMS determined that the evidence was sufficient to cover - under Medicare Part B - a lung cancer screening counseling and shared decision-making visit for appropriate beneficiaries, and an annual screening for lung cancer with LDCT for those individuals if all of the following eligibility criteria were met:
• Age 50 – 77 years;
• Asymptomatic (no signs or symptoms of lung cancer);
• Tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack =20 cigarettes);
• Current smoker or one who has quit smoking within the last 15 years; and,
• An order for the initial lung cancer screening with LDCT (no additional order required for the annual screening).
Before the beneficiary’s first lung cancer LDCT screening, the beneficiary must receive counseling and a shared decision-making visit. The lung cancer screening with LDCT is furnished in a radiology imaging facility that utilizes a standardized lung nodule identification, classification, and reporting system. Reading sites can be a hospital, a physician office or an independent diagnostic testing facility (IDTF).
Lung cancer ranks as the leading cause of death from cancer, due in large part because most diagnoses occur when the patient is in a late stage of the disease. With the right therapy, five year survival in lung cancer patients can exceed 80% for stage one lung cancer, compared with less than 10% for those patients treated when their cancer is in stage four. Lung cancer screening using LDCT is effective in detecting early-stage lung cancer, but much needs to be done to get vulnerable patients tested. Fewer than 5% of eligible individuals currently utilize lung cancer screenings.
We have to be encouraged that CMS is taking steps to facilitate the success of this program. But the ultimate determination of success will be whether lung cancer is detected at a much earlier stage of the disease among the affected population