The decision is appropriate for the Medicare population, and low-dose CT is the correct tool for lung cancer screening, the agency wrote. The CMS first proposed loosening its reimbursement policy in November 2021.
"Based on our review of the available evidence, including clinical guidelines and public comments, we find that the evidence is sufficient to conclude that broadening the eligibility criteria for lung cancer screening with low dose CT is reasonable and necessary for the prevention or early detection of illness or disability and appropriate for Medicare beneficiaries under conditions established in this national coverage decision," the CMS wrote.
The final guideline states that for beneficiaries to be eligible for annual lung cancer screening with low-dose CT, they must meet the following criteria:
- Be between the ages of 50 and 77
- Be asymptomatic (no signs or symptoms of lung cancer)
- Have a tobacco smoking history of at least 20 pack years (One pack year is equal to smoking one pack per day for one year, with one pack equal to 20 cigarettes.)
- Be a current smoker or one who has quit smoking within the last 15 years
- Receive an order for lung cancer screening with LDCT
It also mandates that eligible beneficiaries receive a shared decision-making consultation with their healthcare provider. This visit must include counsel on the importance of annual lung cancer screening, the impact any comorbidities have on lung cancer risk, and the importance of stopping smoking, and it must be documented in the patient's medical record.
The center's decision was prompted in part by a request to reconsider its low-dose CT lung cancer screening coverage policy it received last year from the GO2 Foundation for Lung Cancer, the Society of Thoracic Surgeons, and American College of Radiology (ACR), and definitively brings the CMS in line with an updated recommendation issued in March 2021 by the U.S. Preventive Services Task Force (USPSTF).
The CMS hopes that this expanded coverage will address healthcare inequities -- an issue that has been under much discussion since the USPSTF issued its lung cancer screening update.
"The available evidence ... [suggests] that ... lowering the starting age to 50 years and reducing the smoking history to 20 pack-years may help to partially ameliorate gender and race/ethnicity-related health disparities in eligibility for lung cancer screening," the organization wrote.
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