Medicare panel recommends against payment for CT lung screening tests

May 12, 2014

The Prevent Cancer Foundation was discouraged to learn that a nine-member Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) determined at the end of April that they could not justify having the Centers for Medicare and Medicaid Services (CMS) pay for annual low dose computed tomography (LDCT) scans to detect early lung cancer in former and current heavy smokers. Spiral CT scans detect lung cancer in its early stages and are expected to drop lung cancer mortality rates by 20 percent after the USPSTF recommendations are finalized.

CMS will make a final coverage decision in November and will take this recommendation into account.

In December 2013, the United States Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with CT scans in adults ages 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problems that substantially limit life expectancy or the ability or willingness to have curative lung surgery. This decision carried with it a “B” recommendation which is important, because the Patient Protection and Affordable Care Act requires that all private insurers cover preventive services that receive a “B” recommendation or higher without copay for individuals with private insurance.

The test costs between $300 and $400, which will put it out of reach for many older Americans in need if the MEDCAC recommendation is accepted by CMS and finalized in a national coverage decision.

The Prevent Cancer Foundation has been a leading voice in advocating for high quality, low dose spiral CT screening for those at high risk for developing cancer for many years. Lung cancer continues to be the leading cause of cancer death for both men and women, killing approximately 130,000 Americans each year. The USPSTF estimates that a minimum of 20,000 lives could be saved each year if recommendations are fully implemented.

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