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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that Effective for claims with dates of service on or after February 5, 2015, CMS has determined 
that the evidence is sufficient to add coverage under Medicare Part B a lung cancer screening counseling and 
shared decision making visit, and for appropriate beneficiaries, annual screening for lung cancer with LDCT, as 
an additional preventive service benefit under the Medicare program only if all of the following eligibility 
criteria are met. 
 
Beneficiary Eligibility Criteria 
 
For purposes of Medicare coverage of lung cancer screening with LDCT, beneficiaries must meet all of the 
following eligibility criteria: 
 
    Age 55 - 77 years; 
    Asymptomatic (no signs or symptoms of lung cancer); 
    Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 
1 pack = 20 cigarettes); 
    Current smoker or one who has quit smoking within the last 15 years; and 
    Receive a written order for lung cancer screening with LDCT. Written orders for lung cancer LDCT 
screenings must be appropriately documented in the beneficiary's medical records, and must contain the 
following information: 
        Beneficiary date of birth; 
        Actual pack - year smoking history (number); 
        Current smoking status, and for former smokers, the number of years since quitting smoking; 
        Statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer); and 
        National Provider Identifier (NPI) of the ordering practitioner. 
 
Counseling and Shared Decision Making Visit 
 
Before the beneficiary's first lung cancer LDCT screening, the beneficiary must receive a counseling and 
shared decision making visit that meets all of the following criteria, and is appropriately documented in the 
beneficiary's medical records: 
 
    Must be furnished by a physician (as defined in Section 1861(r)(1) of the Social Security Act) or qualified 
non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as 
defined in 1861(aa)(5) of the Social Security Act), and 
    Must include all of the following elements: 
        Determination of beneficiary eligibility including age, absence of signs or symptoms of lung cancer, a 
specific calculation of cigarette smoking pack-years; and if a former smoker, the number of years since 
quitting; 
        Shared decision making, including the use of one or more decision aids, to include benefits and harms of 
screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure; 
        Counseling on the importance of adherence to annual lung cancer LDCT screening, impact of 
comorbidities and ability or willingness to undergo diagnosis and treatment; 
        Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the 
importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco 
cessation interventions; and 
 
 
        If appropriate, the furnishing of a written order for lung cancer screening with LDCT. 
 
Written Orders for Subsequent Annual Lung Cancer Screenings with LDCT 
 
For subsequent annual lung cancer LDCT screenings, the beneficiary must receive a written order for lung 
cancer LDCT screening. The written order may be furnished during any appropriate visit with a physician (as 
defined in Section 1861(r)(1) of the Social Security Act) or qualified non-physician practitioner (meaning a 
physician assistant, nurse practitioner, or clinical nurse specialist as defined in Section 1861(aa)(5) of the 
Social Security Act). 
 
If a physician or qualified non-physician practitioner elects to provide a lung cancer screening counseling and 
shared decision making visit before a subsequent annual lung cancer LDCT screening, the visit must meet all 
of the criteria described above for a counseling and shared decision making visit. 
 
You can find this information in Medicare's National Coverage Determination (NCD) for Lung Cancer 
Screening with Low Dose Computed Tomography (LDCT) (210.14). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.