Medicare regulators agreed this month to review their coverage decisions for low-dose computed tomography scanning in patients with lung cancer, after being petitioned by leaders from a pair of national healthcare groups.
The agency plans to determine whether the procedure merits grade A (strongly recommends) or grade B (recommends) rating and subsequent coverage under "additional preventive services." The review marks the opening of a 30-day public comment period, with 3 comments listed already on the website for the Centers for Medicare & Medicaid Services.
One such comment came from Atlantic Medical Imaging president & CEO Dr. Robert Glassberg, who said that his radiology practice had been offering free CT scanning for high-risk patients but that the effort needed funding to continue.
"We’ve been offering screening CT for patients at high risk for lung CA for 1.5 years for FREE. We did so because the medical benefit was so compelling," Glassberg wrote. "Sadly, as our belt must tighten each year, such community service could be in jeopardy unless there were to be 3rd party reimbursement. Payment by M’care would set that standard. I strongly support the science behind this exam being both efficacious and cost effective in reducing downstream costs. Reimbursement is needed for it to gain widespread incorporation into community medical practice."
The review was triggered by requests from Memorial Sloan-Kettering Cancer Center’s Center for Health Policy and Outcomes director Peter Bach and Lung Cancer Alliance president & CEO Laurie Fenton Ambrose, according to the CMS memo.
The agency is interested in evidence about proper patient identification, proper length and frequency of screening, facility and provider characteristics, criteria for test positivity, the impact of false positives and follow-up tests and treatments, according to the report. CMS expects to convene a Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) meeting April 30 to review the available evidence.