Medicare now covers annual lung cancer screenings


How will you market this to your patients?

Last month, the Centers for Medicare & Medicaid Services (CMS) issued its final decision that provides for Medicare coverage of screening for lung cancer with low dose computed tomography (LDCT). This decision advocates say will save tens of thousands of lives.

It’s been a controversial issue and some doctors question how many people will benefit from pricey, computed tomography scans to look for early evidence of lung cancer — by far the No. 1 cancer killer in the United States. But Medicare says the benefits are clear. Dr. Patrick Conway, CMO for the Center for Medicare and Medicaid Services said in a press announcement that this is the first time that Medicare has covered lung cancer screenings. “This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States.”

Medicare will pay for a once-a-year, low-dose CT exam for people aged 55-77 who are either current smokers or have quit smoking within the last 15 years; who have a tobacco-smoking history of at least 30 “pack years” (an average of one pack a day for 30 years); and who get a written order from a doctor.

According to the American Lung Association, lung cancer is the leading cause of cancer death for both men and women in the United States. The 5-year survival rate for lung cancer patients is only 16.6 percent. An annual low-dose screening test for individuals at high risk has the potential to dramatically improve lung cancer survival rates by finding the disease at an earlier, more treatable stage. The USPSTF estimates that if everyone who is at high risk is screened, there will be a 14 percent reduction in lung cancer deaths in the United States.

With the reimbursement question now behind us, the challenge now is to ensure we as care providers are investing program infrastructure to support high-quality, evidence-based screening practices.

Although we have seen the number of lung cancer screening programs increase over the years, experts say it’s still tough to get it right due to low volumes, poor reimbursement and the challenge of managing patients’ suspicious findings. But some CT scanner manufacturers are already marketing consulting services and technology to hospitals to help them develop their lung-cancer screening service lines.

Whether you have already launched a program or are starting from scratch, The Advisory Board Company created a handy toolkit to get you on the right track.


For lung cancer screening ICD-10 codes, CLICK HERE.

This post was written and researched by Trish (Skram) Reed. If you have other news, resources or links to share, please comment below or email Trish (Skram) Reed, blogger and research content specialist for WHPRMS, at

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