Medicare will pay for Lung CT Scans

Pack-a-day smokers in Medicare now have access to low-dose CT scans for the early detection of lung cancer. Lung cancer is the leading cause of cancer death among both men and women in the U.S. In 2014 it was estimated that there were more than 224,000 new cases and 159,000 deaths from lung cancer. Approximately 90% of lung cancer deaths among men and 80% of lung cancer deaths among women are due to smoking.

Experts continue to debate whether the benefits are worth the cost and risk of false positives. CMS (Centers for Medicare & Medicaid Services)issued a national coverage determination giving certain Medicare beneficiaries immediate coverage for the screening test.

Some critics say the benefits of aggressive screening have been exaggerated while others point to complexities in setting up an appropriate screening program. Advocates say the technology can help save thousands of lives and lead to better understanding of the disease. CMS says there is sufficient evidence to support covering scans for certain beneficiaries.

Medicare will cover lung CT scans once a year for beneficiaries who meet three key criteria:

• They must be 55-77 years old.
• They must be current smokers or have quit within the last 15 years, with a smoking history of at least 30 “pack years” (meaning they averaged one pack a day for 30 years).
• They must receive a written order from a physician or qualified practitioner. 

In 2013, the U.S. Preventive Services Task Force recommended annual lung cancer screenings using low-dose CT in certain patients, which meant most health insurers were legally required to cover it on a first-dollar basis. However, a Medicare advisory panel recommended against coverage.

The coverage is expected to cost Medicare $9.3 billion over the next five years including the cost of scans, biopsies and treatments.