ACR, 40 orgs call for Medicare coverage of CT lung screening

ACR, 40 orgs call for Medicare coverage of CT lung screening

By Kate Madden Yee, staff writer

March 13, 2014 — The American College of Radiology (ACR) and 40 other medical organizations and healthcare providers are calling for full Medicare coverage for low-dose CT (LDCT) lung cancer screening.

In December 2013, USPSTF recommended screening of adults ages 55 to 80 who have a 30 pack-year smoking history and currently smoke or who have quit within the past 15 years. The agency gave the recommendation a grade of “B,” and the Affordable Care Act (ACA) requires private insurers to cover without a co-pay all medical exams or procedures that receive a grade B or higher from USPSTF. However, the ACA does not specify that Medicare provide full national coverage for beneficiaries.

CMS should provide full national coverage for high-risk patients as defined in the USPSTF recommendations, as well as payment under Medicare’s coverage with evidence development (CED) framework for other high-risk patients not included in the USPSTF recommendations using data collected through existing registries, according to the coalition.

“We strongly urge CMS to implement broad national coverage so that those at high risk can be screened,” said Dr. Douglas Wood, immediate past president of the Society of Thoracic Surgeons.

The groups were specifically concerned about Medicare coverage given the ACA loophole that would enable CMS to avoid reimbursement even as private insurers began paying for scans, the Lung Cancer Alliance said.

“If Medicare does not extend full coverage for lung cancer screening to this population, the net effect will be a two-tier system that leaves Medicare beneficiaries at greater risk of dying from lung cancer than those with private insurance,” said Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance. “This cannot be right.”

National Lung Screening Trial (NLST) results and those of other smaller international randomized, controlled trials show that CT lung cancer screening significantly reduces lung cancer deaths, according to the coalition. Screening current and former smokers with LDCT is the only method ever proved to reduce lung cancer mortality in this high-risk population, and it has also been shown to be cost-effective.

“CMS should act on the USPSTF recommendation to provide national coverage for high-risk Medicare beneficiaries and support quality screening programs across the country,” said Dr. Paul Ellenbogen, chair of ACR’s board of chancellors. “This would, for the first time, enable healers and patients to strike a major blow against the nation’s leading cancer killer.”