CMS recommends screenings for some at high-risk for lung cancer

Medicare should cover annual CT scans for some beneficiaries at high risk of lung cancer, said the CMS Monday in a new proposal that conflicts with a previous recommendation made by a Medicare panel.

The new proposal goes against a decision last year by the Medicare Evidence Development and Coverage Advisory Committee, which voted against covering CT scans for such patients.

But there is broad support for the screenings. The U.S. Preventive Services Task Force recommends that current or past heavy smokers between the ages of 55 and 80 undergo screening. It awarded the screening a “B” recommendation, which means private insurers are required to cover the scans at no cost to certain patients.

The CMS said Monday in a proposed coverage decision that there is enough evidence to support coverage of an annual counseling appointment and then screening as a preventive service benefit if the Medicare beneficiary meets certain criteria. To meet the criteria, a patient:

• Is between 55 and 74 years old
• Shows no signs or symptoms of lung disease
• Smoked one pack of cigarettes per day for at least 30 years
• Currently smokes cigarettes or quit in the last 15 years
• Received a written order for screening by a physician or nonphysician practitioner

In addition, providers will have to submit clinical and follow-up data to a registry that is approved by the CMS. The agency is accepting comments and is expected to issue a final decision early next year.

The proposal was applauded by radiologists as well as manufacturers of CT equipment. “Consistent coverage by commercial and public payers for high-risk individuals is a necessary tool for effective care for the leading cause of cancer death in America,” Dr. Gregory Sorensen, president and CEO of Siemens Healthcare North America, said in a statement.

The American College of Radiology called the coverage proposal a “lifesaver for seniors.”

The screenings can cost between $300 and $400. One study estimates that Medicare could spend up to $9.3 billion over five years to cover the screenings and associated costs for treating lung cancers identified by the scans if the Medicare criteria were the same as the task force's recommendation.

Other groups, such as the American Academy of Family Physicians, believe there is insufficient evidence to support the screenings and raised questions about basing a recommendation on the results of one study.

Follow Jaimy Lee on Twitter: @MHjlee