CMS proposes expanded payment for CT lung cancer screening

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The U.S. Centers for Medicare and Medicaid Services (CMS) on November 17 released a proposed update to its low-dose CT lung cancer screening guideline that would start paying for exams starting at age 50, five years younger than under its current policy.

The move would bring Medicare and Medicaid reimbursement in line with recommendations from the U.S. Preventive Services Task Force (USPSTF), which itself lowered its recommended starting age for screening earlier this year.

The action is an acknowledgment of the severity of lung cancer and its high rates of mortality if it is not caught and treated early -- which is of particular importance in the older Medicare population, CMS said.

"Lung cancer is the third most common cancer and the leading cause of cancer-related death in both men and women in the United States," the agency wrote. "It is an important issue for the Medicare population due to the age at diagnosis and the age at death. In 2021, the National Cancer Institute (NCI) estimated that the number of new cases is over 235,000, with a median age at diagnosis of 71 years."

Like the USPSTF guidance released in March, the proposed guidance from CMS lowers the starting age for screening from age 55 to age 50 and the smoking history from 30 pack years to 20. It also recommends screening for this population in the following cases:

  • If individuals are asymptomatic
  • If a person is a current smoker or has quit smoking within the past 15 years
  • If he or she has been referred by their provider for low-dose CT lung cancer screening

The CMS guidance also states that a beneficiary must attend a shared decision-making visit with their provider that helps them understand the "importance of adherence to annual lung cancer [low-dose CT] screening, [the] impact of comorbidities and ability or willingness to undergo diagnosis and treatment" and smoking cessation counseling.

The proposed recommendation was prompted in part by a letter written by the American College of Radiology (ACR), the GO2 Foundation for Lung Cancer, and the Society of Thoracic Surgeons and sent to CMS March 9, after the USPSTF released its updated guidance. CMS began a national coverage analysis for lung cancer screening on May 18.

"Lung cancer has a generally poor prognosis, with overall observed five-year relative survival of 22.1% in 2013," the agency noted. "However, early-stage lung cancer has a better prognosis and is more amenable to treatment. By leading to earlier detection and treatment, screening for lung cancer can give patients a greater chance for cure."

The USPSTF's revised recommendations have sparked debate among researchers and clinicians as to whether the expanded eligibility will actually address healthcare inequities -- with some arguing that they will and others declaring that they won't -- as well as research on whether broadening the pool of eligible individuals is cost-effective. It remains to be seen whether CMS' proposed changes to its Medicare lung cancer screening guidance will continue to fuel this debate.

CMS is taking comment on its proposed guidance through December 16.

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