Medicare Requirements

Medicare Requirements for Lung Cancer Screening

In light of the positive findings of the National Lung Screening Trial, Medicare coverage of screening for lung cancer with low-dose computed tomography (LDCT) began in 2015. Medicare beneficiaries must meet all of the following criteria:

  • Be 55–77 years of age;
  • Be asymptomatic (no signs or symptoms of lung cancer);
  • Have a tobacco smoking history of at least 30 pack-years (1 pack-year = smoking one pack per day for 1 year; one pack = 20 cigarettes);
  • Be a current smoker or one who has quit smoking within the last 15 years; and
  • Receive a written order for lung cancer screening with LDCT that meets the requirements described in the NCD, including shared decision-making documentation.

Written orders for lung cancer LDCT screenings must be appropriately documented in the beneficiary’s medical record and must contain the following information:

  • Date of birth;
  • Actual pack–year smoking history (number);
  • Current smoking status and, for former smokers, the number of years since quitting;
  • A statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer); and
  • The National Provider Identifier (NPI) of the ordering practitioner.