In order for a patient to be qualified for a low-dose CT of the chest for lung cancer screening, a patient must meet the following high-risk criteria. For:
- Medicare and Medicaid, patients need to be between 55 and 77 with a 30-pack year history of smoking
- Other insurance, patients qualify if aged 50 - 80 with a 20-year history of smoking
Costs & Coverage
In February 2015, the Centers for Medicaid and Medicare Services (CMS) added low-dose CT lung screening to their preventative service benefits for patients who meet eligibility criteria. CMS and most private insurers will reimburse for LDCT lung screening for patients that meet the defined high-risk criteria above. Read the CMS memo.
In 2021, the U.S. Preventive Services Task Force (USPSTF) released new guidelines for lung screening. For patients who are now part of the USPSTF-recommended population for lung cancer screening, referring them for screening is consistent with the latest clinical guidelines.
However, these patients may face certain difficulties with insurance coverage for their screening:
- Medicare beneficiaries in the new group won't have coverage until CMS issues a new NCD that includes them.
- Patients with private insurance can advocate for their coverage using the new USPSTF recommendation as justification of medical necessity. However, when/if their insurance does approve their screening exam, they may charge a co-pay or apply their deductible until the ACA requirement for full coverage goes into effect.
No matter what your patient's financial or insurance coverage may be, we will work with them to meet their needs. We offer a sliding scale rate based off of a patient's financial status.
Shared Decision Making Visit
CMS requires that a shared decision making and counseling visit must take place in order for coverage of a low-dose CT scan of the chest to screen for lung cancer. In an effort to provide comprehensive education to patients and partner with referring providers, we have a dedicated Lung Cancer Screening nurse practitioner who will perform the shared decision making visit and all required documentation requirements. We must receive a referral to the lung cancer screening program in order for the nurse practitioner to perform this visit.
Completing the Referral Process
If your patient is interested in a lung cancer screening, the next step is to place a referral to the program. The Lung Cancer Screening Program nurse practitioner will complete the shared decision making and counseling visit with your patient, provide comprehensive education on risks and benefits, and contact you and the patient with results of the scan.
UVA providers can place a referral in EPIC using the “Lung Cancer Screening” referral.
Providers outside of the UVA system can use the following referral form that can be printed, filled in, and faxed:
Once a referral has been placed, our schedulers will contact your patient. Our schedulers can be contacted at 434.924.9333. Exams can be scheduled at one of the following four locations:
- UVA Hospital
- Emily Couric Clinical Cancer Center
- UVA Imaging at Fontaine
- UVA Imaging at Zion Crossroads
After Your Patient is Screened
Our dedicated Lung Cancer Screening Program nurse practitioner will contact patients with results and discuss recommendations and follow-up.