The Centers for Medicare & Medicaid Services (CMS) is reconsidering the national coverage determination established at section 210.14 of the Medicare National Coverage Determinations manual and proposes that the evidence is sufficient to expand the eligibility criteria for Medicare beneficiaries receiving low dose computed tomography (LDCT) when certain criteria is met.
Beneficiary eligibility criteria:
- Age 50 – 77 years
- Asymptomatic (no signs or symptoms of lung cancer)
- Tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
- Current smoker or one who has quit smoking within the last 15 years
- Receive an order for lung cancer screening with LDCT
Before the beneficiary’s first lung cancer LDCT screening, the beneficiary must receive a counseling and shared decision-making visit that meets all the following criteria, and is appropriately documented in the beneficiary’s medical records:
- Determination of beneficiary eligibility
- Shared decision-making, including the use of one or more decision aids
- Counseling on the importance of adherence to annual lung cancer LDCT screening, impact of comorbidities and ability or willingness to undergo diagnosis and treatment
- Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions
For purposes of Medicare coverage of lung cancer screening with LDCT, the reading radiologist must meet the following eligibility criteria:
- Board certification or board eligibility with the American Board of Radiology or equivalent organization
- Documented participation in continuing medical education in accordance with current American College of Radiology standards
The above proposal simplifies requirements for the counseling and shared decision-making visit, removes the restriction that it must be furnished by a physician or non-physician practitioner, reduces the eligibility criteria for the reading radiologist, and removes the radiology imaging facility eligibility criteria (including removes the requirement that facilities participate in a registry).