Are You Eligible for Lung Cancer Screening Covered by Medicare?

Medicare Covers Lung Cancer Screening for Some

Lung Cancer CT Scan

The cost of your annual lung cancer screening may now be covered by Medicare, according to guidelines released recently by the Centers for Medicare & Medicaid Services (CMS).

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Patients at greatest risk (those who meet specific risk criteria) can now receive coverage for counseling to discuss lung cancer risk and annual low-dose CT screening for lung cancer.

The guidelines were released recently by the Centers for Medicare & Medicaid Services (CMS).

“This is a great decision by CMS,” says Peter Mazzone, MD, MPH, Director of the Lung Cancer Program in Cleveland Clinic’s Respiratory Institute.

“Lung cancer is far and away the leading cause of cancer deaths. If caught early, upwards of 60 to 90 percent of early-stage lung cancer tumors are curable.”

Stemming an epidemic

Lung cancer cases have doubled over the last 30 years, causing nearly 160,000 deaths each year — more than breast, colorectal, prostate and pancreatic cancers combined.

CT scans are currently the only approved way to screen for lung cancer. They detect lung cancer in its early stages — when there often are few, if any, symptoms and when the disease is most treatable.

Yearly low-dose CT scans can make a difference. They have reduced lung cancer deaths among high-risk patients by 20 percent, according to the National Cancer Institute’s National Lung Screening Trial in 2011.

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Criteria for coverage

Under Medicare guidelines, patients are eligible for annual low-dose CT screening for lung cancer if they:

  • Are 55 to 77 years old
  • Are smokers, or past smokers who quit within the past 15 years
  • Have a smoking history equivalent to a pack a day for 30 years
  • Show no signs or symptoms of lung cancer
  • Are healthy enough to tolerate treatment for early-stage lung cancer if needed

Experts say that for patients with severe lung or heart disease or other complex conditions, the risks of lung cancer screening outweigh the benefits. However, if you have new or unexplained cough, shortness of breath or other unexplained symptoms, you should be evaluated rather than undergo screening.

For lung cancer screening, an order from your doctor is required.

Benefits outweigh risks today

“The research has come far enough to know that the benefits of lung cancer screening when used properly — outweigh the harms,” says Dr. Mazzone.

The risks of screening include radiation exposure, false positive results and complications from follow-up diagnostic procedures.

When patients are referred to a high-quality, multidisciplinary program, it lessens the potential for unnecessary diagnostic procedures and overtreatment.

“Outcomes improve when specialists with experience in evaluating and managing lung nodules and early lung cancers are involved,” says Dr. Mazzone.

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For example, patients referred to Cleveland Clinic’s lung cancer screening program are counseled on risks and benefits by a pulmonologist or by a trained physician extender under the supervision of a pulmonologist.

If patients meet the criteria for and consent to screening, low-dose chest CT is performed and interpreted by a chest radiologist.

Should a nodule or early-stage cancer be detected, patients are referred to the Lung Nodule Clinic, where pulmonologists, thoracic surgeons and other specialists discuss further treatment options.

If surgery is required, minimally invasive techniques are used to improve surgical outcomes and ease recovery.

Ensuring best screening tools for future patients

Every lung screening center submits data on each patient’s smoking history, CT dosage and screening results to a CMS-approved national registry.

The registry makes sure that centers produce high-quality results and may further the research and development of new lung cancer screening and treatment tools.

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