On February 10, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Decision to expand reimbursement for lung cancer screening with low-density computed tomography (LDCT).
Lung cancer continues to be the leading cause of cancer-related deaths in the United States, and data shows that individuals diagnosed at an early stage have better outcomes. When detected early, when the cancer is localized to the lungs and has not spread, the 5-year relative survival rate is 59.8%. However, only 18% of lung cancer cases will be diagnosed at this stage when surgery is a potential cure. Instead, 56% of lung cancer diagnoses happen after cancer has metastasized or spread, in the stage when the 5-year relative survival rate is only 6.3%. Low-density computed tomography (LDCT) screening is the technology used for catching and diagnosing lung cancer, and is currently covered for eligible individuals by Medicare, Medicaid, and many private payers.
In 2021, the US Preventive Services Task Force (USPSTF) updated the 2013 lung cancer screening guidelines. The new guidelines expand eligibility for annual screening with LDCT to those aged 50 to 80 years, have a 20 pack per year or more smoking history, and currently smoke or have quit smoking within the past 15 years. The American College of Radiology estimates that the new, expanded screening criteria could save between 30,000 and 60,000 lives per year.
The Centers for Medicare & Medicaid Services (CMS) is a federal agency responsible for administering the Medicare health insurance program at the national level and the Medicaid program (in partnership with state agencies) at the state level. With the change in the USPSTF guidelines in 2021, CMS revised its criteria to cover lung cancer screening with LDCT based on the new USPSTF recommendations. The National Coverage Decision (NCD), released by CMS on February 10, 2022, expanded eligibility for people with Medicare or Medicaid to get LCDT screening. The new NCD lowered the starting age for screening from 55 to 50 years and reduced the tobacco smoking history from at least 30 packs per year to at least 20 packs per year. The new guidelines outlined in the NCD are an exciting step in the right direction for early detection screening.
While the expansion in eligibility is a good starting point, more changes are needed to increase access to LDCT screening. In 2021, LUNGevity submitted public comments to CMS in response to the proposed National Coverage Decision. We requested that the upper age limit of coverage be raised from 77 to 80 to mirror the USPSTF recommendations. However, CMS decided not to follow this recommendation. LUNGevity will continue to seek opportunities to advocate raising the upper age limit and believes that older Medicare beneficiaries should be entitled to lung cancer screening.
LUNGevity Foundation applauds CMS for issuing the National Coverage Decision and expanding LDCT coverage in Medicare beneficiaries. We are pleased that this change will make LDCT screening more accessible for many. If you (or anyone you know) are 50-77 years old with at least a 20 packs per year smoking history, please talk to your primary care physician about getting screened. Screening saves lives!