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More smokers, ex-smokers eligible for lung cancer screening

Washington University School of Medicine

A newly announced federal decision means annual lung cancer screenings are now covered for more smokers and former smokers.

Now, people with Medicare who are ages 50-77 and have a history of heavy smoking qualify for screening with low-dose computed tomography, also called low-dose CT or LDCT.

The noninvasive procedure uses a CT scanner at a low radiation dose to obtain multiple images of the lungs while the individual reclines on an open table without the need for any injections. Washington University radiologists at Siteman Cancer then review the images for abnormalities that could be due to lung cancer.

On Feb. 10, 2022, the federal Centers for Medicare & Medicaid Services (CMS) announced a national coverage determination (NCD) that expanded lung screening coverage. The decision affects only people who have health-care coverage through Medicare. However, employer-sponsored and other private health insurance plans will be required to provide the same coverage in the near future, and it is expected that coverage also will be extended to Medicaid beneficiaries.

The change is aimed at early detection of non-small cell lung cancer and is expected to have a positive impact on the lung cancer mortality rate in the greater St. Louis area. Lung cancer is the leading cause of cancer deaths in men and women in the U.S.

What are the new guidelines?

The change in screening coverage more closely aligns with new screening recommendations approved in 2021 by the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer group of national experts in prevention and evidence-based medicine.

The USPSTF recommends annual lung cancer screening with low-dose CT for adults who:

  • Are 50-80 years old, currently smoke and currently or previously smoked the equivalent of at least a pack of cigarettes per day for 20 years, or
  • Are 50-80 years old, quit smoking in the past 15 years and previously smoked the equivalent of at least a pack of cigarettes per day for 20 years.

With the expansion of screening coverage, lung cancer may be detected earlier for more people when the disease is easier to treat and when better outcomes are more likely.

Does this coverage expansion have limitations?

The CMS decision expands coverage only for people who are covered through Medicare. However, private health insurance plans (including those sponsored by employers) eventually will be required to expand coverage as well, and Medicaid traditionally expands their coverage to match.

That said, there could be a delay in coverage for the following people, which could result in financial barriers.

  • Medicaid beneficiaries ages 50-55 will not have screening coverage until state coverage matches up with the new CMS national coverage determination.
  • Patients with commercial plans may advocate for their immediate coverage using the USPSTF recommendations as justification of medical necessity. However, when/if their plan approves a screening exam, a co-pay or deductible might apply until screening coverage is expanded.

Because of these limitations, a low-dose CT lung screening exam may currently be an out-of-pocket service for those specific groups of people. However, it’s expected that the screening test will be covered for these groups in the future.

To schedule a lung cancer screening, contact Siteman’s Patient Care Coordination Center at 314-788-3731. If you’ve had a screening exam that detected cancer cells and you want to schedule a follow-up appointment with a lung cancer specialist, call 800-600-3606.