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.