Your Toolkit to Implement the Changes Made by CMS to Lung Screening in the US

 

What changes have been made by the CMS to lung screening?

CMS has determined that the evidence is sufficient to expand the eligibility criteria for Medicare beneficiaries receiving low dose computed tomography (LDCT) when the following criteria are met:

  • 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; and

  • Receive an order for lung cancer screening with LDCT.

Counselling and Shared Decision-Making Visit

Before the beneficiary’s first lung cancer LDCT screening, the beneficiary must receive a counselling 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;

  • Counselling on the importance of adherence to annual lung cancer LDCT screening, impact of comorbidities and ability or willingness to undergo diagnosis and treatment; and

  • Counselling 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.

You may read the final decision here.

How to implement the changes made by the CMS to lung screening?

This reconsideration is immediate, meaning all Medicare patients meeting the above criteria are now eligible for a lung cancer screening.  This does not include your patients who have commercial / private insurance (i.e. Humana, Aetna, Anthem, Cigna, UHC, or others), however many have already begun covering with the new criteria.  We strongly recommend you call the commercial / private insurance plan for each patient to ensure coverage.   

Here is a Primary Care Letter template for you to use which announces the new criteria:

 
 

Meet our versatile computed tomography solution, Aida™

 
BlogsSophie Towe