NCD 210.13: Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)
Medicare covers annual LDCT lung cancer screening for current and former smokers meeting USPSTF-aligned criteria with mandatory shared decision-making visit.
What's covered
- Annual LDCT screening
- Initial counseling and shared-decision-making visit
- Lung Cancer Screening Registry participation
Coverage criteria
- Age 50-77
- ≥20 pack-year smoking history (revised 2022 from 30)
- Current smoker OR quit within 15 years
- Asymptomatic
- Shared-decision-making visit before first scan
- Order from qualified provider
- Facility meets LDCT screening requirements
Exclusions
- Symptomatic patients (use diagnostic CT instead)
- Outside age 50-77 range
- Less than 20 pack-year history
Common denial patterns
- Pack-year calculation incorrect
- Missing SDM visit before first scan
- Smoking status timing incorrect
- Facility not LDCT-screening certified
Appeal citation
NCD 210.13 (Lung Cancer Screening with LDCT), 2022 revision (20 pack-year). Document age, pack-years, smoking status, SDM date.
Frequently asked questions
What does Medicare NCD 210.13 cover?
Medicare covers annual LDCT lung cancer screening for current and former smokers meeting USPSTF-aligned criteria with mandatory shared decision-making visit.
What are the coverage criteria?
Age 50-77; ≥20 pack-year smoking history (revised 2022 from 30); Current smoker OR quit within 15 years; Asymptomatic; Shared-decision-making visit before first scan; Order from qualified provider; Facility meets LDCT screening requirements.
What is excluded?
Symptomatic patients (use diagnostic CT instead); Outside age 50-77 range; Less than 20 pack-year history.
How do I cite this NCD in an appeal?
NCD 210.13 (Lung Cancer Screening with LDCT), 2022 revision (20 pack-year). Document age, pack-years, smoking status, SDM date.
Other Preventive/Screening NCDs
Sources
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