Expanded Medicare Coverage
In February of this year, the Centers for Medicare and Medicaid Services (CMS) announced that it was expanding coverage for an early lung cancer detection procedure known as low-dose CT lung screening (LDCTLS). In its official statement, the agency said the move was aimed at improving outcomes for patients with lung cancer, the leading cause of cancer-related mortality in the US. This screening procedure, which can detect lung cancer in its earliest stages, is now accessible to more Medicare recipients, including those who are younger and those who have smoked less over their lifetimes.
Prior to the announcement, Medicare recipients had to be at least 55 years old with at least a 30 pack-year smoking history to be eligible for LDCTLS coverage. (A pack year is the equivalent of one pack of cigarettes per day for a year.) Additionally, patients had to be current smokers or have quit within the past 15 years. Now, patients as young as 50 and with a 20 pack-year smoking history can receive coverage. Dr. Lee Fisher, CMS’s chief medical officer and director of the Center for Clinical Standards and Quality hailed the decision, stating,
Expanding coverage broadens access for lung cancer screening to at-risk populations. Today’s decision not only expands access to quality care but is also critical to improving health outcomes for people by helping to detect lung cancer earlier.
Medicaid and Private Health Insurance Coverage
In March of 2021, the United States Preventive Services Task Force (USPSTF) updated its recommended guidelines for LDCTLS. Previously, the agency had recommended the procedure only for smokers (or those who have quit within the past 15 years) aged 55–80 who had at least a 30 pack-year history of tobacco smoking. Last year, it updated its recommendation, giving a grade of B to the procedure for patients as young as 50 as well as those with 20 pack-year smoking histories. Private insurance plans that are subject to Affordable Care Act requirements, as well as Medicaid plans, must provide coverage for procedures that attain this USPSTF rating.
Please check with your insurance to determine benefit coverage.
More About LDCTLS
LDCTS uses computed tomography (commonly known as a CT or CAT scan) to create a detailed, three-dimensional image of the lungs. In 2011, the National Lung Screening Trial published results of its study of more than 50,000 current and former smokers, which reflected a 15–20% lower risk of cancer mortality among participants who received LDCTLS than those who instead underwent examination using standard X-ray procedures.
Currently, most lung cancers are detected after patients begin experiencing symptoms, which may not occur during the early stages of disease. In fact, a large proportion of lung cancers are discovered only after they have reached an advanced stage. Low-dose CT lung cancer screening allows radiologists to detect abnormalities in the lungs before patients experience symptoms of lung cancer. This can lead to earlier treatment of developing cancers, providing a better chance for recovery and long-term survival.
While only slightly more than six percent of patients survive five years after diagnosis with lung cancer that has spread to distant parts of the body, nearly 60% of patients diagnosed with localized lung cancer reach this milestone. Screening and early detection increase the chances that treatments will be successful.
To learn about LDCTLS at Iowa Radiology, download our brochure!
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