Wellcare Dual Liberty (HMO D-SNP) (001): Screening for Lung Cancer with Low-Dose Computed Tomography (LDCT)

Screening for qualified members. The effects of smoking or exposure to environmental pollutants or workplace toxins may show up many years later.

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Cost
$0
Prior Authorization Required
No
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  1. Schedule a lung cancer screening counseling and shared decision-making visit with your loved one's primary care provider (cannot be scheduled within another visit, it must be a visit specific to lung cancer screening).

  2. Obtain an order for an LDCT lung cancer screening.

  3. Schedule the procedure at a network facility selected by the network provider.

    • It is likely that the scheduling department of that facility will reach out to schedule the LDCT.

  4. Attend the appointment and complete the procedure.

  5. Engage in recommended follow-up treatment and/or referrals.

Eligible members are: people aged 50 – 77 years who have no signs or symptoms of lung cancer, but who have a history of tobacco smoking of at least 20 pack-years and who currently smoke or have quit smoking within the last 15 years, who receive an order for LDCT during a lung cancer screening counseling and shared decision making visit that meets the Medicare criteria for such visits and be furnished by a physician or qualified non-physician practitioner.

For LDCT lung cancer screenings after the initial LDCT screening: the member must receive an order for LDCT lung cancer screening, which may be furnished during any appropriate visit with a physician or qualified non-physician practitioner. If a physician or qualified non-physician practitioner elects to provide a lung cancer screening counseling and shared decision-making visit for subsequent lung cancer screenings with LDCT, the visit must meet the Medicare criteria for such visits.

Availability
Every 12 months for qualified members

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Lung cancer screening is essential for current and past smokers—especially those who still smoke, but including those who have stopped smoking, even if they stopped many years ago.  A long history of smoking still puts them at risk of developing lung cancer.

If your loved one meets all of the following conditions, they are eligible to receive lung cancer screening using low-dose computed tomography (LDCT).

LDCT has been proven to reduce the number of deaths from lung cancer in patients at high risk. LDCT is a CT scan that can produce images of high enough quality to detect lung cancer while using up to 90% less ionizing radiation than a conventional CT scan of the chest.

Before the first screening, your loved one must schedule an appointment with their provider to discuss the benefits and risks of lung cancer screenings. The initial LDCT order must be made during a lung cancer screening counseling and shared decision-making visit (i.e., it cannot be during just any visit, it must be a visit for this specific purpose).

For LDCT screenings after the initial screening, a written order for LDCT by a provider is required, which may be furnished during any appropriate visit.

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