CMS opens review of expanded CT lung screening reimbursement

CMS opens review of expanded CT lung screening reimbursement

By Brian Casey, staff writer

May 18, 2021 — CT lung cancer screening could see expanded Medicare reimbursement soon. The U.S. Centers for Medicare and Medicaid Services (CMS) on May 18 opened up a review of its reimbursement policies in response to recent changes expanding the number of individuals who are eligible to be screened.

CMS on Wednesday issued a national coverage analysis (NCA) tracking sheet for screening for lung cancer using low-dose CT, signifying that it has started the review process. The agency said it opened the review after receiving a formal request to reconsider its national coverage determination (NCD) for CT lung cancer screening.

The agency’s move is in response to new clinical eligibility criteria for CT lung cancer screening issued in March by the U.S. Preventive Services Task Force (USPSTF). The USPSTF’s updated guideline lowered the recommended starting age for screening from 55 to 50 and adjusted the guideline’s smoking history from 30 pack years to 20 pack years. It also reiterated the original “B” grade that USPSTF first gave to CT lung screening in 2013.

In its May 18 announcement, CMS noted that under federal law the agency may cover “additional preventive services” if they receive “A” or “B” ratings from the USPSTF — a standard that the expanded lung screening criteria now meet. A review of Medicare coverage was requested by the American College of Radiology (ACR), the Society of Thoracic Surgeons, and the GO2 Foundation for Lung Cancer.

In announcing its expanded criteria in March, the USPSTF noted that expanding the range of eligibility for lung screening would increase by 87% the number of people able to be screened, a number that ranged from 80% in men to 96% in women. Minorities would also see a big increase in the number of people eligible.

Despite winning approval from USPSTF in 2013 and Medicare reimbursement shortly thereafter, CT lung cancer screening has underperformed expectations. The percentage of eligible individuals who seek out screening remains at single-digit percentages in some studies, far below that of mammography, colon screening, and other more established screening procedures.

The USPSTF guideline change apparently spurred CMS into action, a move that was urged by a number of groups, including the ACR. The groups have also asked CMS to eliminate its requirement that individuals undergo a “shared decision-making process” with their physicians before starting screening — a rule that’s not required of other screening exams. CMS did not mention shared decision-making in its NCA tracking sheet.

CMS said that it is seeking public comment on the request through June 17; comments can be submitted on the agency’s website.

The ACR said it is pleased that CMS acted so quickly on its request to open a national coverage analysis to make its lung cancer screening guidelines mirror those of the USPSTF. Updating Medicare coverage rules would support the expansion of screening eligibility, and would also enable doctors to start conversations with patients, according to Dr. Debra Dyer, chair of the ACR Lung Cancer Screening Steering Committee.

“This would help ease lung cancer outcomes disparities — particularly among women, Black men, and those in rural areas,” Dyer said. “We look forward to working with CMS to update its coverage policy, which would enable the medical community to strike a blow against the nation’s leading cancer killer by using lung cancer screening to its full advantage.”