New Expanded USPSTF Lung Cancer Screening Guidelines
July 21, 2021 | 2 min. to read
The United States Prevention Services Task Force (USPSTF) recently broadened their Grade B recommendation for lung cancer screenings. The age range was expanded from 55 to 77 years of age to between 50 and 80, and smoking history was lowered 30 to 20 packs per year or greater. Although other eligibility criteria were kept the same — current smoker, or if a former smoker, quit within the past 15 years — the two new guidelines are exciting news for patients.
“We expect the changes to the USPSTF recommendations to nearly double the population eligible for lung cancer screening,” says Eric Hart, MD, NM medical director for lung cancer screening. “More importantly, the changes should help address disparities in lung cancer screening, since it is known that certain groups on average, particularly Black Americans, Native Americans and women, develop lung cancer at a younger age and with a less intensive smoking history than other groups, such as Caucasian men. “
Under the Patient Protection and Affordable Care Act, most insurance plans are required to cover preventative services with a USPSTF Grade B or higher recommendation, with no out-of-pocket expense. However, the timing of required coverage for changes in USPSTF recommendations is not immediate. Most commercial plans have until January 1, 2023, to begin requiring coverage under the new recommendations. CMS is not bound to USPSTF recommendations, and therefore, Medicare and Medicaid have not changed their eligibility criteria for Lung Cancer Screening as of this date: 55-77 years of age, 30 pack-year or greater smoking history, current smoker or quit within past 15 years.
NM has made recent investments in its Lung Cancer Screening program by:
Purchasing radiology software and establishing a system-wide leadership team
Convening a system-level working group with physicians from several disciplines and operational leaders from all NM regions to work together to create synergies and standards for screening
Continuing to work with Epic to develop order processes that are flexible with changing USPTSF requirements, which will help expand screening to others
Launching a new webpage to help patients learn about the Lung Cancer Screening program at nm.org/lungscreening
“We are working hard behind the scenes to make this transition happen for our patients, with no out-of-pocket expense to them, prior to the January 1, 2023, the required date for commercial insurance coverage,” adds John Heinrich, NM administrative director for lung cancer screening. “We ask for your patience while we work with commercial carriers to become early adopters, and while we make changes to Epic to make it easier for you to successfully order lung cancer screening under the new criteria.”