As part of the Affordable Care Act, effective Oct. 1, 2014, annual screening for lung cancer using low-dose computer tomography (CT) will be covered with no cost sharing for members who receive this service from an in-network provider and meet all of the following criteria:
- Are between ages 55 and 80
- Have a 30 pack per year smoking history
- Currently smoke or have quit in the past 15 years
Prior authorization by National Imaging Associates is required for outpatient diagnostic imaging, including low-dose CT lung cancer screening. To obtain prior authorization, please visit the NIA website www.RadMD.com or call 800-642-7543. For more information, including applicable codes, please refer to the CT Screening for Lung Cancer Medical Policy.
The ACA permits certain "grandfathered" plans to be exempt from some of its provisions. Therefore, members should check with their employers to see if the benefits detailed here apply to their particular plan.