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Medicare announces increased coverage options
e-Reports, Feb. 23, 2015
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The Centers for Medicare & Medicaid Services (CMS) in a national coverage determination earlier this month advised that Medicare will cover lung cancer screening with low-dose computed tomography, effective immediately.

“This is an important preventive benefit for long-term smokers or former smokers,” said Jeri Biedenkopf, R.N., ISMA practice advisor. “It’s the first time Medicare has ever covered screenings for lung cancer.”

Perhaps because lung cancer is now the third most common cancer and the leading cause of cancer deaths in the country, CMS agreed to screenings for Medicare patients who:

  • Are age 55 to 77
  • Smoke currently or quit within the last 15 years
  • Have a history of smoking at least 30 “pack years,” meaning an average of one pack a day for 30 years
  • Receive a written order from a physician or qualified non-physician practitioner who meets certain requirements

The coverage includes a visit for counseling and shared decision making about the benefits and risks of lung cancer screening. Certain requirements exist for radiologists and imaging centers. For details, see the CMS website.

Plus – new model for cancer care
CMS also recently announced a new multi-payer payment and delivery model to support better care coordination for cancer patients. The initiative includes giving patients undergoing treatment 24-hour access to practitioners and rewarding doctors for value, not volume.

The move was prompted by feedback from the medical, consumer and business communities. Physician groups and solo practitioners who provide chemotherapy for cancer and are currently enrolled in Medicare may apply to participate.

Learn more about this new Oncology Care Model here.

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