A few weeks ago, The Society of Thoracic Surgeons (STS) and Lung Cancer Alliance (LCA) joined ACR in asking CMS for a meeting to discuss efforts for the implementation of a proposed Medicare benefit covering low-dose CT lung cancer screening for high-risk beneficiaries. The scientific basis justifying low-dose CT screening is the National Lung Screening Trial (NSLT), a randomized, multicenter clinical study, administered by the American College of Radiology Imaging Network. The study found that based on experience with over 50,000 patients chosen to undergo three annual screenings of either low-dose CT or chest radiography, patients who received annual low-dose CT screenings were 20 percent less likely to die of lung cancer than patients who underwent annual chest X-rays. This study was cited in the United State Preventive Services Task Force’s (USPSTF) Grade B recommendation for low-dose CT lung cancer screening for high-risk asymptomatic individuals, finalized on Dec. 31, 2013. This recommendation was an update to USPSTF’s 2004 recommendation, when the USPSTF concluded insufficient evidence existed to recommend for or against screening for lung cancer in asymptomatic persons with low-dose CT, chest radiography, sputum cytologic evaluation, or a combination of these tests.
Under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, CMS has authority to extend coverage to preventive services that meet certain requirements, including USPSTF Grade A or B recommendations. Since the passage of MIPPA, CMS has opened several NCDs on screening, bringing Medicare coverage policies in line with USPSTF’s recommendations. Given the availability of new evidence, USPSTF’s update to its recommendation, and CMS’ recent history of working with professional societies in formulating coverage policy, CMS is likely to expand coverage of lung cancer screening to high-risk beneficiaries. A positive coverage decision would not only lead to more lung cancer screening within the Medicare population, but could also compel private payers to revisit their coverage policies.
ACR is currently developing a comprehensive screening protocol including practice guidelines and appropriateness criteria, which ACR expects to complete in the coming months. Medicare will likely wait to open an NCD until this protocol is released so that it can inform its coverage decision.