Medicare Expands Eligibility for Lung Cancer Screenings
The Centers for Medicare and Medicaid Services has expanded coverage for Medicare recipients who qualify for low-dose CT scan lung cancer screenings.
The change lowers the starting age for screening with a low-dose CT scan from 55 to 50, and reduces the tobacco smoking history from at least 30 packs per year to at least 20 packs.
The move to expand coverage came on the heels of new recommendations by the United States Preventive Services Task Force that heavy smokers should receive preventative screenings for lung cancer. It recommended the new regimen as an important step saving lives through early detection.
Under the new rules, Medicare will cover low-dose CT scan lung cancer screenings for Medicare beneficiaries who:
- Are between the ages of 50 and 77,
- Show no signs of lung cancer,
- Have an extensive tobacco smoking history (20 packs per year),
- Are current smokers or smokers who quit within the past 15 years, and
- Receive a provider's order to undergo CT scan screening.
Procedures
To be eligible for coverage, before the first screening beneficiaries must receive a counseling on lung screening and abstinence or quitting smoking by their doctor in a process called "shared decision-making."
This must be documented in the beneficiary's medical records.
Shared decision-making must include the use of one or more decision aids:
- Counseling on the importance of adherence to annual lung cancer low-dose CT screening, the impact of comorbidities, and the ability or willingness to undergo diagnosis and treatment;
- Counseling on the importance of continuing not to smoke cigarettes for people who have quit; and
- Counseling on the importance of giving up the habit if the beneficiary is a current smoker. That can include furnishing them with information about tobacco cessation interventions.
Why it's important
This change in coverage is important considering that 87% of Medicaid beneficiaries who were eligible to receive lung cancer screenings did not receive one, according to a 2021 study by Epic Health.
Lung cancer screening for heavy smokers saves lives. Detecting cancer early can result in a much better quality of life and survival rate than if it's caught later.
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