On February 10th, the Centers for Medicare and Medicaid Services (CMS) finalized their proposal to align coverage with updated lung cancer screening guidelines issued by the United States Preventative Task Force (USPSTF) in March of 2021.

Under the new guidelines, the starting age for lung cancer screening decreases by five years and lowers the number of smoking history pack years from 30 to 20.

For beneficiaries to be eligible for annual lung cancer screening with low-dose CT, they must meet the following criteria under the new guidelines:

  • Be between the ages of 50 and 77
  • Be asymptomatic (no signs or symptoms of lung cancer)
  • Have a tobacco smoking history of at least 20 pack years (One pack year is equal to smoking one pack per day for one year, with one pack equal to 20 cigarettes.)
  • Be a current smoker or one who has quit smoking within the last 15 years
  • Receive an order for lung cancer screening with LDCT

The coverage decision also mandates that eligible beneficiaries undergo a shared decision-making consultation with their provider. This consultation must include discussion on the importance of annual lung cancer screening, the impact of comorbidities on lung cancer risk, and the importance of quitting smoking. This also must be documented in the patient’s medical record.

As always, ADVOCATE will continue to keep you informed on the issues impacting medical groups as they develop.

Kayley Jaquet

Manager, Regulatory Affairs