Computed Tomography (CT) Scanning for Lung Cancer Screening
Low-dose computed tomography (LDCT) is a radiographic technique that provides high-quality, three-dimensional images of the lungs with less radiation exposure than conventional high-resolution CT scanning. This imaging technique has been proposed for screening asymptomatic, high-risk individuals for early lung cancer lesions.
LDCT uses either spiral (also referred to as helical) or electron beam (also referred to as ultrafast) CT scanning. Compared with conventional CT scans, these scans allow for the continuous acquisition of images, thus shortening the scan time and radiation exposure. A complete spiral or ultrafast CT scan can be obtained within 10-20 seconds, or during one breath hold for the majority of individuals. The radiation exposure for this exam is greater than that of a chest x-ray but much less than a conventional CT scan.This policy applies to individuals with no signs or symptoms suggestive of underlying lung cancer. In symptomatic individuals, a diagnostic work-up appropriate to the clinical presentation should be undertaken.
Low dose computed tomography scanning (e.g., helical, ultrafast) is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Low dose computed tomography scanning (e.g., helical, ultrafast) as a screening technique for all other indications is considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
Low dose computed tomography scanning (e.g., helical; ultrafast) is considered medically appropriate if ALL of the following criteria are met:
When performed as a screening technique for lung cancer on an individual considered to be a potential candidate for curative treatment
The individual is between 55 and 80 years of age
The individual has no signs or symptoms suggestive of underlying lung cancer
The individual has at least a 30 pack-year smoking history and ANY ONE of the following: (See additional information below for definition of a pack-year)
The individual stopped smoking within the past 15 years
Individual has not received a low-dose CT lung screening in less than 12 months
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According to the U.S. Preventive Services Task Force (USPSTF), “a ‘pack year’ means that someone has smoked an average of one pack of cigarettes per day for one year. For example, a person reaches 30 pack years of smoking history by smoking one pack per day for 30 years or two packs per day for 15 years.”
American Association for Thoracic Surgery. (2012, July). The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. Retrieved March 21, 2017 from http://aats.org.
American Cancer Society. (2019). Lung cancer screening guidelines. Retrieved March 22, 2019 from https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/lung-cancer-screening-guidelines.html.
American College of Chest Physicians. (2018, April). Screening for Lung Cancer CHEST Guideline and Expert Panel Report. Retrieved April 13, 2018 from http://www.chestnet.org.
American Society of Clinical Oncology (ASCO). (2012). The role of CT screening for lung cancer in clinical practice. Retrieved March 22, 2019 from https://www.asco.org/practice-guidelines/quality-guidelines/guidelines/thoracic-cancer#/10211.
Centers for Medicare & Medicaid Services. CMS.gov. NCD for lung cancer screening with low dose computed tomography (LDCT). Retrieved March 22, 2019 from https://www.cms.gov.
National Comprehensive Cancer Network. (2018, August). NCCN Clinical Practice Guidelines in Oncology. (NCCN Guidelines®). Lung cancer screening (V.2.2019). Retrieved March 21, 2019 from the National Comprehensive Cancer Network.
U.S. Preventive Services Task Force. (December, 2013). Screening for lung cancer: U. S. Preventive Services Task Force recommendation statement. Retrieved March 22, 2019 from www.USPreventiveServicesTaskForce.org.
Usman, A., Miller, J., Peirson, L., Fitzpatrick-Lewis, D., Kenny, M., Sherifali, D., & Raina, P. (2016). Screening for lung cancer: a systematic review and meta-analysis. Preventive Medicine, 89, 301-314. Abstract retrieved March 22, 2019 from PubMed database.
Wang, Z., Hu, Y., Wang, Y., Han, W., Wang, L., Xue, F., et al. (2016). Can CT screening give rise to a beneficial stage shift in lung cancer patients? Systematic review and meta-analysis. PLoS One, 11 (10), e0164416: doi: 10.1371/journal.pone.0164416. (Level 1 evidence)
ORIGINAL EFFECTIVE DATE: 10/1/2003
MOST RECENT REVIEW DATE: 4/11/2019
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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