Lung Cancer Screening Update
As this valuable coverage rolls out to patients, the Commission on Economics works to tie up loose ends with CMS.
On April 6, Dr. Ella A. Kazerooni and I gave a webinar on lung cancer screening. More than 1,500 people signed up for the webinar. We were able to accommodate only 1,000, so a recorded version is available.
It’s not surprising that so many of you have questions. CMS announced that it would cover lung cancer screening with CT for eligible smokers and ex-smokers aged 55–77 back in November 2014, when the agency issued a proposed decision memo, which it made final (accepting almost all of the ACR’s suggested changes) in February 2015. But, as of now, there is no way to get paid for providing this service to Medicare beneficiaries. It is technically a “covered service,” so you cannot bill the patient. So what should you do?
Here’s what we suggest for now: become an ACR designated lung screening center, hold your claims, and gather the data you will need to input into the ACR registry (expected to launch in June 2015). Registry participation will be required for payment.
Your ACR has been working hard to make sure that payment for this life-saving service is set at a rate that will ensure access for Medicare beneficiaries. Immediately after the final coverage decision memo was published, the Commission on Economics along with Dr. Kazerooni met with both the coverage and the payment groups at CMS. The coverage group (with whom we worked throughout 2014 to make the case for CMS to pay for lung cancer screening with CT) will issue a change request, which will then allow the payment group to issue a payment structure. We were told that we should expect this process to take several months. We emphasized to the CMS staff that practices are unlikely to be willing or able to ramp up the service as quickly as would be optimal to start saving lives if they don’t know how or when they are going to get paid.
We discussed with both groups our belief that low-dose CT for lung screening is a fundamentally different and overall more intense and challenging examination to interpret (and with more associated costs) than a chest CT without contrast. The need to ensure quality, verify appropriate patient selection, track patient outcomes, and read the noisy low-dose images all make for a harder examination. All of this was covered when we submitted to CMS a detailed assessment of the work and resources involved.
Because taking a new service through the normal CPT and RUC process would mean that payment could not be established in 2015, we asked CMS to consider implementing a G code for lung screening CT. CMS can create these at any time and can set payment rates. Those of us who perform and interpret mammograms are familiar with the G codes, which were created for full-field digital mammography in 2000.
Private payers are already required to pay for lung screening with low-dose CT in 2015, depending on when their plan year starts. For those payers, you can submit claims using the S code created in October 2014 (S8032 low-dose computed tomography for lung cancer screening). We hear that some payers are suggesting you use the CPT code for a non-contrast chest CT, but we do not agree with this. It is critically important that these CTs be easily tracked so that screening can be effectively administered and we can learn how to improve it. Lumping screening CT in with regular chest CT will not achieve that goal.
We are delighted that 688 practices have already become ACR Designated Lung Cancer Screening Centers. I am proud of the program that we as radiologists have developed to find lung cancer while it can still be effectively treated. We’re reached this point through our collaborative advocacy efforts with patient advocacy groups, the American Cancer Society, and other physician stakeholder groups. Our clear plan for a robust quality program and the credible science underpinning our efforts were critical factors in persuading CMS to cover this service.
By Geraldine B. McGinty, MD, MBA, FACR, Chair