The Centers for Medicare and Medicaid Services (CMS) has issued a proposal to revise their low-dose CT lung cancer screening guidelines to align with updates made by the U.S. Preventive Services Task Force (USPSTF). Earlier this year, the USPSTF lowered the recommended starting age and smoking history for lung cancer screenings, expanding the number of patients eligible for screenings. The new guidance adjusts the task force’s 2013 recommendation and now states that adults between the ages of 50 and 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should undergo annual screening for lung cancer with low-dose CT. The CMS action acknowledges the importance of detecting lung cancer early and would align reimbursement to pay for exams for those that now qualify under the guidelines.
The proposed guidance from CMS lowers the starting age for screening from age 55 to age 50 and the smoking history from 30 pack years to 20. It also recommends screening for this population in the following cases:
- If individuals are asymptomatic
- If a person is a current smoker or has quit smoking within the past 15 years
- If he or she has been referred by their provider for low-dose CT lung cancer screening
The CMS guidance also states that a beneficiary must attend a shared decision-making visit with their provider that helps them understand the importance of lung cancer screenings and discuss smoking succession. CMS is taking comment on its proposed guidance through December 16, 2021.
CMS’s proposal is available here: NCA – Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439R) – Proposed Decision Memo (cms.gov)
As always, ADVOCATE will continue to keep you informed on the issues impacting medical groups as they develop.
Manager, Regulatory Affairs