CMS/Medicare Announces Immediate, Final Decision to Pay for Low Dose CT Scans for Some Persons at Ri
Finding cancers early is increasingly possible, and it’s being done more and more often. Persons involved in toxic tort litigation and precision medicine topics can benefit from following the developments and anticipating the consequences.
An example arises from use of low dose CT scans to enhance earlier finding of lung cancers. On that topic, note CMS’ February 5, 2015 press release announcement of its final decision to pay for low dose CT scans for a defined subset of current and former smokers who are 55-77, and who are current smokers or quit in the prior 15 years (other criteria also apply – see below). The full CMS “decision memo” is online and useful.
Per CMS’ press release, the decision took effect “immediately.”
Note also that results of the screens must be contributed to a national “registry,” as explained in the following subpart of the decision:
“Radiology imaging facility eligibility criteria: ….
“Collects and submits data to a CMS-approved registry for each LDCT lung cancer screening performed. The data collected and submitted to a CMS-approved registry must include, at minimum, all of the following elements:”
As to the criteria for scans, CMS explains them as follows:
“The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, annual screening for lung cancer with low dose computed tomography (LDCT), as an additional preventive service benefit under the Medicare program only if all of the following criteria are met:
Beneficiary eligibility criteria:
Age 55 – 77 years;
Asymptomatic (no signs or symptoms of lung cancer);
Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);
Current smoker or one who has quit smoking within the last 15 years; and
Receives a written order for LDCT lung cancer screening that meets the following criteria:
For the initial LDCT lung cancer screening service: a beneficiary must receive a written order for LDCT lung cancer screening during a lung cancer screening counseling and shared decision making visit, furnished by a physician (as defined in Section 1861(r)(1) of the Social Security Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Social Security Act). A lung cancer screening counseling and shared decision making visit includes the following elements (and is appropriately documented in the beneficiary’s medical records):For subsequent LDCT lung cancer screenings: the beneficiary must receive a written order for LDCT lung cancer screening, which may be furnished during any appropriate visit with a physician (as defined in Section 1861(r)(1) of the Social Security Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the Social Security Act). If a physician or qualified non-physician practitioner elects to provide a lung cancer screening counseling and shared decision making visit for subsequent lung cancer screenings with LDCT, the visit must meet the criteria described above for a counseling and shared decision making visit.
Determination of beneficiary eligibility including age, absence of signs or symptoms of lung cancer, a specific calculation of cigarette smoking pack-years; and if a former smoker, the number of years since quitting;
Shared decision making, including the use of one or more decision aids, to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure;
Counseling on the importance of adherence to annual lung cancer LDCT screening, impact of comorbidities and ability or willingness to undergo diagnosis and treatment;
Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions; and
If appropriate, the furnishing of a written order for lung cancer screening with LDCT.
Written orders for both initial and subsequent LDCT lung cancer screenings must contain the following information, which must also be appropriately documented in the beneficiary’s medical records:
Beneficiary date of birth;
Actual pack – year smoking history (number);
Current smoking status, and for former smokers, the number of years since quitting smoking;
Statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer); and
National Provider Identifier (NPI) of the ordering practitioner.