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March 27, 2018


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Medical Coding News Archives

Medicare Now Covers Lung Cancer Screening

 
February 19, 2015:

The Centers for Medicare and Medicaid Services announced February 5 that Medicare will now cover lung cancer screening for the first time. The national coverage determination states that lung cancer with low-dose computed tomography (LDCT) will be covered effective immediately.

Lung cancer is the leading cause of death from cancer in the United States and the world, according to the American Lung Association. It is estimated that more Americans will die from lung cancer in 2015—160,000 people—than from colorectal, breast, and a prostate cancer combined.

Early detection can change treatment success dramatically, however. The overall five-year survival rate for lung cancer is 17.8 percent, but 54 percent if the cancer is detected when still localized to the lung, the American Cancer Society reports. Currently, only 15 percent of cases are detected at this earliest stage.

Beginning immediately, Medicare will cover a once-yearly screening for beneficiaries who meet all of the following criteria:

  • They are ages 55 to 77 and either smoke currently or quite smoking within the last 15 years.
  • They are asymptomatic.
  • They smoked for at least 30 “pack years” (averaged one pack a day over the course of 30 years).
  • They have a written order from a physician or qualified nonphysician practitioner.

Medicare will cover the screening itself as well as a visit for counseling and shared decision-making about the risks and benefits of the procedure.

 

 
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