Medicare coverage updates include revised criteria for lung cancer screening and a code for a newly approved COVID-19 treatment
Lung cancer screening using low-dose CT now will be covered when provided to younger patients and those with a shorter history of smoking.
CMS in February amended its coverage criteria for lung cancer screening and issued a code for a newly approved COVID-19 treatment.
A new national coverage determination (NCD) for lung cancer screening with low-dose computed tomography modifies previous coverage guidelines. The new NCD lowers the starting age for screening to 50 and allows for screening if a patient has smoked an average of a pack per day for 20 years. Previously, the minimum age was 55 and the minimum number of “pack-years” was 30.
The guidelines also aim to:
- Streamline criteria for the mandatory counseling and shared decision-making visit that precedes the initial screening
- Reduce administrative burden on providers by removing the requirement for the reading radiologist to document participation in continuing medical education
A code for a new COVID-19 treatment
CMS also established a code for outpatient treatment of COVID-19 for patients who have immunosuppressive disease or are getting immunosuppressive treatment.
HCPCS code C9507 is available for treatment using COVID-19 convalescent plasma in those patients. The code can be applied to services furnished on or after Dec. 28, which aligns with the FDA’s emergency use authorization of the treatment.
Details of the new code include:
- Status indicator: S
- APC: 1509 (New Technology — Level 9)
- Long descriptor: Fresh frozen plasma, high titer COVID-19 convalescent, frozen within 8 hours of collection, each unit
- Short descriptor: COVID-19 convalescent plasma
The Medicare payment rate for the treatment is $750.50.
These details can be found on CMS’s Hospital Outpatient PPS page.