In March 2021, the U.S. Preventive Services Task Force (USPSTF) released updated recommendations for lung cancer screening, which expand the eligibility criteria for this cost-effective, life-saving test. The ACR and other professional associations are advocating for the Center for Medicare and Medicaid Services (CMS) to update its Lung Cancer Screening National Coverage Determination to reflect the expanded USPSTF guidelines. The Affordable Care Act requires private insurers to adopt updated USPSTF guidelines within one year. Until the new criteria is adopted by CMS and private insurers, please continue to use the established lung cancer screening criteria (see table below). We will continue to monitor CMS and the private insurers and will update you as soon as we are able to implement the new criteria.
|
LUNG CANCER SCREENING |
Current Insurer Criteria |
Updated USPSTF Recommendations (Pending) |
|
Age |
55-77 |
50-80 |
|
Cigarette smoking-pack years |
At least 30 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
This eligibility criteria expansion is great news for our region as lung cancer remains the second most common cancer and the leading cause of cancer deaths in the United States. Annual lung cancer screening in high-risk patients with low dose CT significantly reduces lung cancer mortality by up to 26%. Lung cancer screening has strict criteria for patient eligibility, patient counseling, order criteria, imaging parameters, and reporting.
“In partnership with Munson Healthcare, we instituted a comprehensive Lung Cancer Screening Program in 2015,” said Patrick Gartland, MD; Grand Traverse Radiology, PC. “Our program participates in the American College of Radiology (ACR) Lung Cancer Screening Registry and all facilities have been recognized as Designated Lung Cancer Screening Centers. We are happy to report that through March of 2021, we have detected over 100 lung cancers throughout our system with this program in place. We would like to thank the Primary Care Providers who are an essential part of an effective lung cancer screening program, particularly through counseling your patients on smoking cessation and the benefits of screening. Together we are all making a difference in our communities.”
A reminder that the CPT code used when ordering Initial/Annual CT Lung Cancer Screening Low Dose CT has changed to 71271.
Questions:
- Kendra Worden, NP; MHC Multidisciplinary Thoracic Oncology Program
- Patrick Gartland, MD; Grand Traverse Radiologists, PC