Medicare Requirements

STS and two other medical specialty societies have asked CMS to expand Medicare coverage of lung cancer screening in light of new recommendations from the USPSTF on March 9, 2021.

 

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.