CMS finalizes plan to offer Medicare coverage for CT scans among smokers

In an effort to detect lung cancer, the Centers for Medicare & Medicaid Services finalized plans to offer Medicare coverage for CT scans, or low-dose computed tomography (CT), among smokers aged 55-77.

The agency estimates that almost 160,000 Americans died from lung or bronchus cancer in 2013.

The preliminary decision, announced in November, won praise from industry, trade groups like the Lung Cancer Alliance, and doctors. However it was made against the advice of the Medicare Evidence Development & Coverage Advisory Committee, which last year said there isn't enough evidence to support the initiative.

The final National Coverage Decision is similar to the preliminary proposal. It applies to smokers who have a smoking history of at least 30 "pack-years," or an average of one pack a day for 30 years. The final decision increase the maximum age for eligibility to 77, up from 74 in the proposal.

As in the proposal, the patient must be a current smoker or have quit within the last 15 years, CMS said. A written order for LDCT lung cancer screening obtained during a "lung cancer screening counseling and shared decision-making visit" is also required. The requirement that radiologists reimbursed under program enter the data into a CMS-approved data registry are also unchanged.

The three main providers of imaging devices--GE Healthcare ($GE), Siemens, and Philips ($PHG)--all sell CT scanners.

Courtesy of the Centers for Medicare & Medicaid Services

CMS stressed that CT scanning technology has improved, writing in a decision memo, "Most modern CT machines take continuous pictures in a helical (or spiral) fashion rather than taking a series of pictures of individual slices of the body, as the original CT machines did. Helical CT has several advantages over older CT techniques: it is faster, produces better 3-D pictures of areas inside the body, and may detect small abnormalities better."

The agency cited numerous studies in support of its decision, including the National Lung Screening Trial, sponsored by the federal National Cancer Institute. "The NLST showed that people aged 55 to 74 years with a history of heavy smoking are 20 percent less likely to die from lung cancer if they are screened with low dose helical CT than with standard screening chest x-rays. Previous studies had shown that screening with standard chest x-rays does not reduce the mortality rate from lung cancer," CMS wrote in the decision memo.

During a CT scan, "a motorized table moves the patient through a circular opening in the CT imaging system. While the patient is inside the opening, an X-ray source and a detector assembly within the system rotate around the patient. A single rotation typically takes a second or less. During rotation, the X-ray source produces a narrow, fan-shaped beam of X-rays that passes through a section of the patient's body." CMS wrote.

Detectors in rows opposite the X-ray source register the X-rays that pass through the patient's body as a "snapshot" in the process of creating an image. Many different snapshots (at many angles through the patient) are collected during one complete rotation. For each rotation of the X-ray source and detector assembly, the image data are sent to a computer to reconstruct all of the individual snapshots into one or multiple cross-sectional images (slices) of the internal organs and tissues.

The decision memo also contains the agency's response to critiques made during the decision's public comment period.

- read the release
- here's the decision memo

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