Lung Screening Eligibility...Will it Stay "as is" or Receive a Facelift

Posted by Cam McClellan Teems

July 28, 2015 at 4:30 PM


Although screening for lung cancer has been around for a brief period of time, most of our clients are reporting that they see many people who would likely benefit from screening, but who do not meet the "tipping-point" current recommendations (30 pack/year smoking history).   This appears to be region specific.  Per the CDC, current cigarette smoking is higher in the Midwest and South than in the Northeast and West.2

The 30 pack/year smoking history is not the only recommendation that currently limits those who could benefit from screening.  However, it appears to be the one component that is not quite over the threshold for its group. Currently, only people older than 50 years with a smoking history of more than 20 years and at least one other risk factor, or those older than 55 years with a smoking history of 30+ pack/year who has quit smoking more than 15 years before screening are eligible.1

Since CMS has agreed that low-dose lung cancer screening is appropriate for people who are covered by Medicare and are older than 55 years with the guideline-stated smoking history and/or other risk factors, it seems probable that this will remain the standard - at least for awhile or until the Lung Screening Registries have enough data to report otherwise.

Those providing LDCT must:

  • Utilize a standardized lung nodule identification, classification and reporting system;
  • Make available smoking cessation interventions for current smokers; and
  • Collect and submit data to a CMS-approved registry for each LDCT lung cancer screening performed.

However, as of this writing (July 2015), CMS is not yet paying for this screening for Medicare patients.  Most Lung Screening Programs are charging $99-$250 per scan upfront.


Topics: Cancer Management, Screening, Industry News, Certification & Accreditation

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