Medicare Coverage of Lung Cancer Screening Guidance

Medicare Coverage of Lung Cancer Screening Guidance

Beneficiary Eligibility Criteria Expanded 

  • Lowered the starting age for screening from 55 to 50
  • Reduced the tobacco smoking history from at least 30 packs per year to at least 20 packs per year


Counseling and Decision-Making Visit

  • Lung cancer screening LDCT counseling visits can now be done via telehealth visits (this change was made permanent in 2/10/2022)
  • The visit can be done by a provider, non-physician practitioner, or an auxiliary personnel incident to a physician's professional service

Required Elements of the Shared Decision-Making (SDM) Visit

  • Patient must be between the age of 50-77
  • Asymptomatic; No signs or symptoms of lung cancer
  • Tobacco smoking status (Current smoker or Quit within last 15 years) - Document Quit Year in Order
  • Smoking History of 20 pack-years or more
  • Literature only applicable to patients who smoke cigarettes
  • Use of one or more decision aids that includes: Benefits and harms of screening, importance of getting screened every year, impact of comorbidities
  • Visit should also discuss patient's ability or willingness to undergo diagnosis and treatment
  • Harms of screening may include: follow-up diagnostic testing, over diagnosis, false positives, and total radiation exposure
  • Counseling on importance of smoking abstinence if former smoker or importance of smoking cessation if current smoker.
  • For current smokers, provider can send referral to the Parkland Smoking Cessation Clinic, Texas Quit Line, or COPC Smoking Cessation Classes