Most Insurance Covers Lung CT Screenings

March 21, 2016

Did you know that The U.S. Centers for Medicare and Medicaid Services and private insurers cover low-dose CT scans for lung cancer screening?  As of Jan. 1, 2015, The Affordable Care Act requires that private insurance plans cover the lung cancer screening. Some insurance plans require the screening to be preauthorized. Check your insurance plan about coverage requirements. CMS recently approved a decision to cover the cost of the CT lung cancer screening for Medicare recipients.

Medicare will cover annual CT scans for beneficiaries who:
•    Are between ages 55 and 77;
•    Currently smoke or have quit smoking within the past 15 years and have a smoking history of 30 "pack years" or more, meaning they averaged at least one pack daily for 30 years; and
•    Receive written orders from a provider.

Supporters of the screenings argue that the tests can help save thousands of lives and bolster understanding of lung cancer.

Previously, no screening exam existed for lung cancer, and as such, patients were often diagnosed at a late stage where treatment options are limited. In December 2013, we hit an important milestone with the United States Preventive Services Taskforce (USPSTF) awarding lung cancer screening a “B” rating, which ensured commercial payer coverage starting in 2015. CMS’s decision to cover lung cancer screening represents a huge step forward in ensuring comprehensive access to this life-saving service for all eligible patients.

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If a patient is uninsured, Springhill offers this exam for $199 (includes the radiologist reading fee).

Download the SMC Lung CT Order sheet.