Medicare Coverage for Low Dose CT Lung Cancer Screening Battle Ongoing

The National Lung Screening Trial was initiated as early as 2002. In 2010, initial result were published in the New England Journal of Medicine (NEJM). The study was closed early because of the conclusive findings of at least 20 percent mortality benefit with low dose CT screening in the high risk population.

In December 2013, the United States Preventive Services Task Force (USPSTF) determined that lung cancer screening indications were a “Grade B” for high risk individuals. The Affordable Care Act (ACA) requires that private insurers cover all medical exams or procedures that receive a grade of “B” or higher. The ACA, however, does not specify that Medicare provide the same coverage.

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) met on April 30. Those opposed to low dose lung cancer screening argued that the money is better spent on smoking prevention programs. MEDCAC’s scoring of CT lung cancer screening reflected a recommendation against covering seniors for the test.

So now we have two government advisory bodies on opposite sides of an issue. We have a two-tiered system where many privately insured patients are getting the imaging that they need, and is indicated, while Medicare beneficiaries may be denied coverage.

ACR maintains clinical research as one of its fundamental pillars. Research is critical for the profession and our patients. We stand with nearly 40 other professional societies and alliances in urging Center for Medicare & Medicaid Services (CMS) to cover seniors for these proven lifesaving exams.

The radiology community will have an opportunity to weigh in again when CMS makes its recommendations in a proposed decision memo – scheduled to be released Nov. 10, 2014. We may seek legislative options as well. As before, we will be relying on your grassroots support to help underscore the effort.

Howard B. Fleishon, MD, MMM, FACR

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