As reported last year, the U.S. Preventive Services Task Force (USPSTF) has updated their guidelines for lung cancer screening by expanding the eligibility criteria for age and pack years.* CMS released their updated guidelines on Feb. 10, which now reflect the USPSTF guidelines for pack years but not age. The chart below lists updated criteria for both CMS (Medicare/Medicaid) and some commercial insurance. NOTE: Difference in age criteria.*
To offer lung cancer screenings to as many patients as possible, Munson Healthcare uses the criteria accepted by each insurance provider. Patients and providers should check with their individual insurance providers to determine coverage prior to ordering a lung cancer screening for commercial insurance.
LUNG CANCER SCREENING |
CMS Criteria (as of 2/10/22) |
2021 USPSTF Criteria |
Age |
50-77 |
50-80* |
Cigarette smoking-pack years |
At least 20 pack-years |
At least 20 pack-years |
Asymptomatic |
No acute symptoms |
No acute symptoms |
Smoking Status |
Current or quit within last 15 years |
Current or quit within last 15 years |
LDCT Lung Cancer Screening Order (strict criteria) |
Required |
Required |
Shared-Decision Making Visit |
Required |
Required |
*Expanded criteria (now accepted by some insurers but NOT CMS)
The Lung Cancer Screening Order (form #11404) is available on the Provider Forms webpage. Cerner Ambulatory Orders will be updated on Monday, March 7.
A reminder that the CPT code used when ordering Initial/Annual CT Lung Cancer Screening Low Dose CT is 71271.
Questions: Stephanie LaMont, (231-935-7210 Radiology Scheduling); Brian Mier, (231-935-6518 CT); Amanda Stuart, (231-392-8537 Oncology Support Services)