Medicare will pay for lung cancer screening for many longtime smokers

November 10, 2014 | by Nicole White

Former smokers age 55 to 74 who rely on Medicare for health care services have just received a long-hoped-for announcement. Under a proposed decision from the Centers for Medicare and Medicaid Services, they'll now have access to lung cancer screening with a low-dose CT scan.

lung cancer screening Medicare may cover lung cancer screening with low-dose CT scans for smokers ages 55 to 74 with a 30-year pack history.

The proposed decision, announced Monday, comes about seven months after a nonbinding panel shocked lung cancer doctors and experts nationwide by recommending against paying for the potentially lifesaving screening. The U.S. Preventive Services Task Force had already embraced such screening in the wake of the National Lung Screening Trial, which determined that the scans are effective in detecting early-stage lung cancer. Private plans were (and still are) expected to cover the screening beginning in 2015.

“I think it’s great Medicare is going to be covering lung cancer screening,” said Dan Raz, M.D., co-director of City of Hope’s Lung Cancer and Thoracic Oncology Program. “Lung cancer is such an important disease and education is so important to predicting death.”

While the Centers for Medicare and Medicaid Services (CMS) news is mostly good, it’s not without drawbacks. First, Medicare is covering people only up to age 74 – not age 80, as the U.S. Preventive Services Task Force recommended. Second, Medicare is mandating that all participating centers must submit data to a CMS-approved registry to get reimbursement – and there is no such registry right now.

“That’s going to be a big barrier to accepting Medicare for a lot of centers,” Raz said.

The CMS eligibility criteria include:

  • Be age 55 to 74
  • Have no signs or symptoms of lung disease
  • Have a smoking history of 30 pack-years (smoking the equivalent of a pack per day for 30 years)
Medicare will also cover a lung cancer screening counseling and shared decision-making visit. The current proposal is open for public comment, and a final recommendation is expected to be adopted in early 2015.

Lung cancer is the leading cause of cancer death in the United States, killing nearly 160,000 people each year. Almost 90 percent of people who develop lung cancer die from the disease, in part because it’s often not detected until it has already advanced and spread.

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Learn more about lung cancer treatment and research at City of Hope. For more information on lung cancer screening, call 626-218-9410 or e-mail [email protected] to speak with someone from the Lung Cancer Screening Program.

Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

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