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  • Writer's pictureKirk Hartley

CMS Seeks Input on Approval of Low Dose CT Scans for Reimbursement

Watch for a continued increase in low dose CT scans for lung cancers in persons with greater than usual risks. Use of low dose CT scans grew over the last few years, with mounting evidence to support efficacy and adoption by courts for medical monitoring remedies In NY, the Court of Appeals recently issued a terse opinion that narrowly declined to adopt a broad medical monitoring cause of action against big tobacco, but the opinion explicitly confirmed the medical monitoring remedy is available when harm has been shown. Elsewhere, the high courts of Maryland and Massachusetts recently approved medical monitoring remedies, with the Massachusetts court issuing a sweeping, unanimous 2009 opinion that broadly embraced new science and medical monitoring.

Now, CMS has issued a notice seeking public comment on approval of low dose CT scans for reimbursement under certain circumstances, and setting a meeting for April 30, 2014. The CMS web site includes a synposis, and it states:

"Effective January 1, 2009, CMS is allowed to add coverage of "additional preventive services" if certain statutory requirements are met. Per Section 1861(ddd) of the Social Security Act and implementing regulations at 42 CFR 410.64, CMS may cover "additional preventive services", if it determines through the national coverage determinations (NCD) process that the service is recommended with a grade A (strongly recommends) or grade B (recommends) rating by the United States Preventive Services Task Force (USPSTF) and that it also meets certain other requirements.

CMS has accepted two formal complete requests to initiate a NCA on Lung Cancer Screening with Low Dose Computed Tomography (LDCT), which is recommended with a grade B by the USPSTF for certain persons at high risk for lung cancer based on age and smoking history. The scope of our review is limited to LDCT Screening for lung cancer. We are particularly interested in evidence to inform the identification of patients eligible for screening; the appropriate frequency and duration of screening; facility and provider characteristics that predict benefit or harm; precise criteria for test positivity and the impact of false positive results and followup tests or treatments. We are also soliciting input on the influence of these factors on patient education and informed consent in Medicare beneficiaries including the elderly and younger disabled populations and persons receiving dialysis treatment for end stage renal disease; and on the integration of smoking cessation interventions for current smokers.

On April 30, 2014, we are convening a Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) meeting to review the available evidence on this topic."

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