Annual screenings for older, long-term smokers will now be covered by Medicare

November 12, 2014

Annual screenings for long-term smokers aged 55 to 74 will now be covered by Medicare, the Centers for Medicare and Medicaid Services (CMS) announced on Nov. 10.

Annual screenings for long-term smokers aged 55 to 74 will now be covered by Medicare, the Centers for Medicare and Medicaid Services (CMS) announced on Nov. 10.

The draft decision provides a “lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, screening for lung cancer with low dose computed tomography (LDCT).” Screening for lung cancer with LDCT is not currently covered by Medicare.

“Given the burden of lung cancer on the United States population, a suitable screening test for lung cancer has been sought for many years,” the draft reads.

Lung cancer is the leading cause of cancer deaths in the U.S, according to CMS, and the third most common cancer.

The number of new cases in 2013 exceeded 220,000, according to the National Cancer Institute, and the average age at diagnosis is 70.

Private insurers must cover the screenings as a provision of the Affordable Care Act.

Summarized data on the decision-making criteria is viewable here.

Screenings criteria is as follows:

  • Age 55-74 years;

  • Asymptomatic (no signs or symptoms of lung disease);

  • Tobacco smoking history of at least 30 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; and

  • A written order for LDCT lung cancer screening that meets specific criteria