Current and former heavy smokers ages 55 to 77 can undergo , the Centers for Medicare and Medicaid Services announced Thursday.
The decision finalizes a preliminary plan the agency released in November with one important difference: a higher upper limit to the age range, which had previously been set at 74.
As in the draft plan, individuals must still have a 30 pack-year history of smoking to qualify and must either be smoking currently or have quit in the past 15 years.
Also, beneficiaries must obtain a written order from a physician for the first screening, stipulating that the patient underwent counseling on lung cancer screening and that it involved a shared decision-making process. Subsequent annual screenings will also require similar written orders.
The counseling sessions must emphasize the importance of continued abstinence for ex-smokers and cessation for current smokers.
Another important feature of the new benefit is that radiology facilities performing the screening must submit data on every patient screened to a CMS-approved registry. Those data must include the CT dosage, patient's smoking status and history, and the indication for screening (i.e., symptomatic versus no signs of lung cancer), among others.
That Medicare decided to cover the screening was something of a surprise, as its major coverage advisory committee had recommended against it last April. At the time, panel members said the evidence of benefit for Medicare beneficiaries was inadequate, in light of high false-positive rates, uneven scan quality, and variability among radiologists in interpreting the images.
Following the November announcement, many questioned the upper age limit of 74 that CMS proposed. In an informal survey of 51˶ readers, with more than 8,500 responses, nearly two-thirds said there should be no upper limit.
Now CMS has pushed it up to 77 , but whether that will change opinions remains to be seen.