The U.S. Preventative Services Task Force is making recommendations to nearly double the number of people eligible for tests. The recommendation is seeking to lower the starting age for lung cancer screening from 55 to 50.
USPSTF is also recommending expanding the high-risk population to include those who smoked the equivalent of a pack of cigarettes a day for 20 years, rather than a 30 pack-year history. This change applies to adults between 50 and 80 years who currently smoke or have quit within the past 15 years.
Not Too Fast....
Some hospitals are moving forward with the recommendations, while payors are working through the changes.
CMS Update
In May, the GO2 Foundation for Lung Cancer, The Society of Thoracic Surgeons, and American College of Radiology® (ACR®) petitioned for a change to the CMS National Coverage Determination policy. While CMS accepted their request, the completion date is not expected until February 2022.
Aetna Update
Aetna revised their lung cancer screening coverage policy in accordance with USPSTF recommendations. Aetna’s coverage policy, retroactive to March 8, covers annual low-dose computed tomography (LDCT) for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years.
BCBS of Kansas Update – Effective date September 1, 2021
BCBS of Kansas followed suit and revised its lung cancer screening coverage policy. BCBS of Kansas coverage policy, effective September 1, 2021, will also allow for annual low-dose computed tomography (LDCT) for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years
Medicaid and Other Payors
Medicaid Services (CMS) is also considering an adjustment to its reimbursement policy for low-dose CT lung cancer screening. While there has been no formal announcement of change other payors are considering some form of adoption of as well.
