03/22/2017

CMS Clarifies Coverage Rules for Lung Cancer Screening with Low Dose Computed Tomography

AQI Members: 

In response to requests from AQI and other stakeholders, CMS has confirmed that all outpatient imaging facilities, including IDTFs, may perform and bill low dose CT (LDCT) lung cancer screening if the facility meets the National Coverage Determination (NCD) requirements. The NCD coverage requirements for LDCT may be found here: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274.

Importantly, Medicare Administrative Contractors (MACs) may not deny coverage based on the facility’s enrollment in the Medicare program as an IDTF.  We understand that certain MACs have denied claims for LDCT lung cancer screening when performed in the IDTF setting despite the IDTF meeting the NCD criteria. Please contact me if you have concerns about Medicare coverage of LDCT lung cancer screening.

Best,

Maggie Sayre