New CMS Rule Interpretation Could Block Access to Lung Cancer Screening

A recently updated CMS interpretation of Medicare regulations excluded coverage of low-dose computed tomography screenings (LDCT) for lung cancer patients performed at independent diagnostic testing facilities (IDTF) because this procedure is not considered a diagnostic test.

According to a press release, this ruling has been met with opposition from health care associations including, the American College of Radiology (ACR) the Radiology Business Management Association (RBMA), the Association for Quality Imaging (AQI) and MedQuest Associates.  In a statement from RBMA, officials suggested that this ruling could prevent lung cancer patients from getting the care they need by drastically reducing their access to timely and local screening facilities.

“This very literal interpretation is at odds with existing practices and broader policies, such as the Bipartisan Budget Act of 2015 that is encouraging hospitals to set up more off-campus IDTF imaging centers to care for patients with greater efficiency and at lower cost,” the statement said.
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LDCT is a diagnostic procedure usually performed in a hospital or an outpatient-imaging center. These centers are designated as IDTFs under Medicare regulations for legal purposes. IDTFs are currently approved to provide only diagnostic services to Medicare and Medicaid patients, such as ultrasounds and CT scans. However, regulatory Medicare coding does not consider LDCT a diagnostic procedure.

According to the release, this ruling is not associated with any quality concerns raised by the CMS. IDTFs are required to fully comply with Medicare program rules, such as accrediting all CT scanners and having all services performed under the supervision of a Board-certified radiologist.

RBMA officials emphasized that this interpretation puts the lives of cancer patients at risk because LDCT is the only test currently approved for screening lung cancer. The ACR has sent a letter to Tamara S. Syrek Jensen, JD, director for the Coverage and Analysis Group at CMS outlining these concerns. —David Costill