Medicare now covers screening for pulmonary malignancy with LDCT starting at age 50.
After reconsideration of eligibility criteria, the Centers for Medicare & Medicaid Services (CMS) announced on Feb. 10 a national coverage determination (NCD) that expands coverage for lung cancer screening with low dose computed tomography (LDCT) for Medicare patients. This move is in line with current recommendations from the U.S. Preventative Services Task Force and proves the agency is catching up to coverage already offered by some private insurers. The end goal — facilitate earlier detection and treatment of non-small cell lung cancer (NSCLC), which, in turn, will improve health outcomes for people battling lung cancer.
Broader LDCT Coverage, Revised Requirements
Two major changes in the reconsidered NCD will likely double the number of people for whom lung cancer screening is covered. CMS’ decision expands eligibility for lung cancer screening with LDCT by moving the starting age to 50, down from 55. The agency also reduced the tobacco smoking history needed to qualify, now covering LDCT screening for people with a 20 pack-year smoking history, down from the cutoff of at least 30 packs per year. The NCD also:
> Simplifies requirements for the counseling and shared decision-making visit;
> Removes the requirement for the reading radiologist to document participation in continuing medical education; and
> Adds back a requirement for radiology imaging facilities to use a standardized lung nodule identification, classification, and reporting system.
These changes will have a huge impact, increasing access to lung cancer screening for at-risk populations.
Lung cancer is the third most common cancer and the leading cause of cancer-related death in both men and women in the United States. According to estimates, 236,740 Americans will be diagnosed with lung cancer in 2022. The good news — the number of new lung cancer cases is steadily declining. From 2009 to 2018, the incidence rate decreased by 2.8 percent per year in men and 1.4 percent per year in women.
Interestingly, lung cancer accounts for 12 percent of all new cancer diagnoses but 22 percent of all cancer deaths. And with a median age at diagnosis of 71 and median age at death of 72 years, according to the National Cancer Institute’s 2021 estimates, this proves to be an important issue for the Medicare population.
LDCT Coding and Coverage
Screening plays a key role in the fight against certain types of lung cancer. In fact, early detection of high-risk cases can reduce the chance of death by up to 20 percent. Use the following codes to report lung cancer screening services:
HCPCS Level II code for the counseling and shared decision-making visit required before the patient’s LDCT screening: G0296 Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making)
CPT code for the LDCT scan:
71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
Applicable ICD-10-CM codes include Z87.891 Personal history of nicotine dependence and those that fall under subcategory F17.21 Nicotine dependence, cigarettes.
Annual LDCT screening is covered for Medicare Part B patients when certain conditions — i.e., eligibility criteria and counseling and shared decision-making visit criteria — are met; the patient will not be responsible for copayment, coinsurance, or deductible.
For more information, visit: https://www.aapc.com/blog/84090-ldct-coverage-expanded-to-enable-earlier-detection-of-lung-cancer/