Next week, CMS' Medicare Evidence Development and Coverage Advisory Committee will consider arguments calling for national Medicare coverage of low-dose computed tomography (LDCT) screening for patients with histories of significant smoking who are at high risk for lung cancer. According to proponents of the change in coverage, at stake in the April 30 MedCAC meeting are the lives of literally thousands of Americans.
The American College of Radiology (ACR), the Lung Cancer Alliance, the Society of Thoracic Surgeons and 38 other medical organizations are urging CMS to provide full national coverage for high-risk patients per the December 2013 recommendations of the United States Preventive Services Task Force.
The USPSTF recommended annual screening for lung cancer with LDCT in asymptomatic adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The task force also recommended that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
"MedCAC should recommend, and CMS should implement, broad national coverage for CT lung cancer screening so that those at high risk can be tested and thousands of people each year can be saved from this terrible disease, says Ella Kazerooni, M.D., chair of the ACR Committee on Lung Cancer Screening.
The USPSTF recommendation is based largely on results of the National Lung Screening Trial (NLST), which found that CT lung cancer screening (3 annual LDCTs) in high risk individuals significantly reduces lung cancer deaths. The NLST enrolled patients who were between 55 and 74 years of age at the time of randomization, had a history of cigarette smoking of at least 30 pack-years, and, if former smokers, had quit within the previous 15 years.
The Affordable Care Act requires that private insurers cover all medical exams or procedures without a co-pay that receive a grade B recommendation or higher from the USPSTF--which the LDCT lung cancer screening did receive in December from the task force. However, the ACA does not specify that Medicare provide full national coverage for beneficiaries.
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