ACR hopes for good news from CMS on CT lung screening

This November could be the most significant Lung Cancer Awareness Month in history, if Medicare approves full coverage of CT lung cancer screening for seniors 65 years and older, the American College of Radiology (ACR) said in a statement.

The U.S. Centers for Medicare and Medicaid Services (CMS) is required to rule by November 10 on whether it will pay for CT lung cancer screening tests for Medicare beneficiaries. If approved, CT lung cancer screening could become one of the biggest health policy initiatives in the U.S. in years.

The debate over Medicare reimbursement has been turbulent, though. Last December, the U.S. Preventive Services Task Force (USPSTF) gave a "B" grade to CT screening for individuals younger than 65 who have a minimum 30-pack-year smoking history or who have quit within the past 15 years. That triggered a requirement that private health insurance plans pay for screening under the terms of the Affordable Care Act.

However, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) in April came to a contrary finding, giving CT screening a vote of low confidence. If CMS follows the MEDCAC panel's recommendation, private payors could be reimbursing for screening exams that Medicare beneficiaries will go without.

The proscreening community believes many of the objections raised by the MEDCAC panel have been addressed.

"Medical experts and patient advocates have outlined to Medicare the infrastructure and quality assurance programs in place," said Dr. Ella Kazerooni, chair of the ACR Lung Cancer Screening Committee and ACR Thoracic Imaging Panel, in a statement. "Questions regarding CT lung cancer screening effectiveness, cost, and patient acceptance are answered. It is time for Medicare to move forward with full coverage."

Coverage for screening is an urgent matter due to the large number of people affected by lung cancer, advocates claim.

"More than 220,000 people will be diagnosed with lung cancer this year, and nearly 160,000 people will die from the disease," said Dr. Douglas Wood, immediate past president of the Society of Thoracic Surgeons. With this proven test, tens of thousands can be saved, he added.

The Lung Cancer Alliance advocacy group noted that lung cancer claims more lives each year than breast, prostate, and colon cancer combined, and CT screening can save more lives than any cancer test in history.

"However, Medicare must ensure access to these exams by providing full coverage for them," said Laurie Fenton Ambrose, president and chief executive officer of the group.

A large coalition of medical societies, professional and public health leaders, and members of Congress have called on CMS to fully reimburse the exams for seniors, ACR said.

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