Monday, February 9, 2015

Medicare Will Cover Limited Lung Cancer Screening

By Rebecca Adams

The Centers for Medicare and Medicaid Services will cover screening for lung cancer for the first time for certain beneficiaries, the agency said last week. The coverage for lose dose imaging takes effect immediately.

“This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States,” said Patrick Conway, chief medical officer and deputy administrator for innovation and quality for CMS.

Under the final decision, Medicare will cover the screening once a year for Medicare beneficiaries who are between 55 years old and 77 years old, and are either current smokers or quit smoking within the last 15 years. To qualify, the beneficiaries also must have smoked an average of one pack a day for 30 years and must get a specific type of written order from a physician or qualified non-physician practitioner.

A trial of about 54,000 people showed that CT scans may allow some cancers to be caught earlier and thus allow people to live longer with the deadly disease. A National Cancer Institute summary of  trial results found about 18 people in 1,000 who were given CT tests died of lung cancer after about 6.5 years, compared with 21 in 1,000 whose lungs were scanned with older X-rays. But 25 in 1,000 people in the CT group had a false alarm leading to an invasive procedure, such as biopsy, or surgery, while the rate was seven in 1,000 in the x-ray group.

Medicare coverage includes a visit for counseling on the benefits and risks of lung cancer screening.

“We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program,” Conway said.

“This decision is a triumph for Medicare beneficiaries who are at high-risk for lung cancer and will now have access to life-saving scans,” said Gail Rodriguez, executive director of the Medical Imaging & Technology. “Given the high bar CMS holds in making national coverage determinations, it is clear that the benefits of LDCT [low-dose computed tomography] scans for those at high risk of lung cancer are indisputable.”

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