Lung Cancer: New Screening Guidelines and Reimbursement Protocols


Jan Marie Eberth

Dr. Eberth Interview with:
Jan Marie Eberth, PhD
Assistant Professor, Department of Epidemiology and Biostatistics
Deputy Director, SC Rural Health Research Center
Core Faculty, Statewide Cancer Prevention and Control Program
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208

Medical Research: What is the background for this study?

Dr. Eberth: With the breakthrough findings of the National Lung Screening Trial released in 2011, professional organizations have largely embraced population-based screening guidelines for patients at high risk for lung cancer. The diffusion of screening into broad clinical practice has been slow to be adopted, given concerns about the efficacy of screening in community settings, lack of insurance reimbursement and unclear billing logistics, and difficulty weighing the pros of screening against the known cons (e.g., high rate of false positives).

Medical Research: What are the main findings?

Dr. Eberth: Provisions of the Patient Protection and Affordable Care Act mandate that US Preventive Services Task Force-recommended screening tests with an A or B rating receive full insurance coverage by private payers. The Centers for Medicare and Medicaid (CMS) soon thereafter approved full coverage for lung cancer screening in high-risk patients (i.e., those aged 55-77 years, asymptomatic for lung cancer, tobacco smoking history of 30+ pack-years, is a current smoker or has quit smoking within the past 15 years).

Coding is rapidly evolving; as of November 2015, CMS released HCPCS codes G0296 (pre-screening counseling visit) and G0297 (screening visit). These codes will be accepted retroactively starting January 4, 2016 to the date of the final coverage determination (back to February 5, 2015). No coinsurance or deductibles shall be charged to the patient for either the pre-screening counseling visit, or the screening visit itself.

Quality of screening  is an important, but understudied, area of research. Several publications have focused on aspects of quality programs, and how to achieve quality benchmarks, but data is still being collected to assess variation across programs. In the future, data from screening registries, such as the American College of Radiology Lung Cancer Screening Registry (LCSR), can be leveraged to examine these quality metrics and improve risk-prediction models for lung cancer.

Medical Research: What should clinicians and patients take away from your report?

Dr. Eberth: Primary care providers should become familiar with the recently-released screening guidelines and reimbursement protocols for lung cancer screening. As the gatekeepers to screening, primary care providers play an important role in helping their patients make informed screening decisions and providing the appropriately documented referral needed to get their patients screened. Decision aids offer valuable information to both patients and their providers in this process.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Decision aids that elicit patients values about screening are sorely needed, as physicians grapple to explain the risks and benefits of screening to their patients and how to account for factors such as patient comorbidities, opinions of family members, and adherence to annual screening regimens. Additionally, research on utilization and predictors of screening is needed to assess screening efficiency at the population level.


Lung Cancer Screening With Low-Dose CT in the United States.

[wysija_form id=”5″]

Dr. Jan Eberth (2015). Lung Cancer: New Screening Guidelines and Reimbursement Protocols 

Last Updated on January 2, 2016 by Marie Benz MD FAAD