In early 2024, the US Centers for Medicare & Medicaid Services (CMS) cut reimbursement for low-dose computed tomography (LDCT) lung cancer screening by roughly 30–40%, a decision that surprised many oncologists and public-health researchers. Within months, screening uptake among Medicare beneficiaries dropped by an estimated 20–30%, according to preliminary analysis of radiology claims. The cut was justified by CMS as a correction for what it viewed as overpriced reimbursement relative to clinical value, but critics argue it undermines years of progress in detecting lung cancer at earlier, more treatable stages.

A Reimbursement Cut That Reshaped Screening

Lung cancer remains the leading cause of cancer death in the United States, accounting for roughly 130,000 deaths annually. The five-year survival rate for cases caught early — stage I or II — is around 60%, but for advanced-stage disease it drops below 10%. Screening high-risk individuals with annual LDCT has been shown in large trials to reduce lung-cancer mortality by 20–24%.

Medicare began covering LDCT screening in 2015, following the US Preventive Services Task Force (USPSTF) recommendation. For nearly a decade, reimbursement rates were stable, hovering around US$ 150–200 per scan. Then, in late 2023, CMS announced it would recalibrate the payment based on a revised cost-effectiveness analysis, effectively slashing the reimbursement to roughly US$ 100–120 per scan. The change took effect January 1, 2024.

The decision reflected a broader CMS push to align payments with what it terms “value-based care.” In a publicly posted memo, the agency argued that LDCT screening had a higher false-positive rate than originally modeled, leading to unnecessary follow-up procedures and patient anxiety. It also cited overdiagnosis — the detection of indolent cancers that would never have caused symptoms — as a factor that diminished the net benefit of widespread screening.

Yet the magnitude of the cut caught many providers off guard. “We expected some adjustment, but not this deep,” said Dr. Andrea McKee, a radiation oncologist at Boston Medical Center, in a March 2024 interview. “The message to primary-care clinicians was that screening is less valuable than we thought. That’s not what the data show.”

Why the Cut Targeted Low-Dose CT

LDCT screening has been a contentious topic in radiology and oncology since the National Lung Screening Trial (NLST) showed a 20% mortality reduction in 2011. The USPSTF gave it a B grade, and Medicare coverage followed. But the test is not perfect. False-positive rates in the NLST were about 24%, leading to additional scans, biopsies, and, in rare cases, complications. Overdiagnosis estimates varied from 10% to 20% in different analyses.

Critics of broad screening, including some health economists, argued that the cost per quality-adjusted life year (QALY) gained was higher than for other preventive services, such as colonoscopy or mammography. CMS’s internal modeling, released in draft form in September 2023, suggested that reducing reimbursement would not only save the program money but also decrease the volume of low-value scans among patients at lower risk — a group that had grown as awareness increased.

The policy shift was also influenced by the 2020 update to the USPSTF guidelines, which expanded eligibility to younger adults (age 50–80) and those with a lighter smoking history (20 pack-years instead of 30). This broadened the pool of potential screenees, raising concerns about capacity and cost. CMS officials argued that the lower reimbursement would encourage providers to focus on high-risk populations rather than expanding screening to marginal candidates.

But many oncologists saw the cut as a step backward. “Screening is one of the few tools we have to improve survival in lung cancer,” said Dr. Peter Mazzone, director of the lung cancer screening program at the Cleveland Clinic. “Cutting reimbursement sends a signal that this is not a priority, and that has ripple effects beyond just the payment amount.”

The Immediate Drop in Screening Rates

Claims data from the first half of 2024, compiled by the American College of Radiology, showed a sharp decline in LDCT procedures billed to Medicare. Compared to the same period in 2023, volumes dropped by roughly 22% nationally, with some regions seeing declines of more than 30%. The drop was most pronounced in community hospitals and independent radiology practices, which operate on thinner margins than large academic centers.

Several factors drove the decline. Some radiology groups stopped offering screening altogether because the new reimbursement fell below their operating costs. Others reduced hours or limited slots. Patients faced higher out-of-pocket costs: for example, at one community practice in rural Ohio, the patient copay for a screening LDCT rose from roughly US$ 25 to US$ 60 after the cut, as the practice began balance billing to cover the gap. For low-income beneficiaries, even a small copay can be a deterrent.

The decline was not uniform across demographic groups. Preliminary analyses suggest that screening rates fell more steeply among Black and Hispanic beneficiaries, as well as those in rural areas, widening existing disparities. “We are seeing a reversal of the slow but steady progress we made in the last decade,” said Dr. Ella Kazerooni, a radiologist at the University of Michigan and chair of the American College of Radiology’s lung cancer screening committee. “The patients who need screening most are the ones losing access.”

Data from the National Cancer Institute’s SEER registry are not yet available for 2024, but modeling studies — such as one by the Cancer Intervention and Surveillance Modeling Network (CISNET) — project that a 20% drop in screening could lead to a 5–10% increase in advanced-stage diagnoses over the next two to three years. That translates to hundreds of additional deaths annually, according to some estimates.

Expert Disagreement Over the Evidence

The CMS reimbursement cut has exposed a deep divide among experts about the real-world effectiveness of LDCT screening. On one side are those who point to the NLST and the Dutch-Belgian NELSON trial, which showed a 24% mortality reduction in men and 33% in women. These trials, they argue, provide strong evidence that screening saves lives, and the challenge is to implement it effectively, not to reduce access.

On the other side are skeptics who question whether the trial results translate to routine practice. They note that in community settings, false-positive rates can be higher, follow-up compliance lower, and the risk of overdiagnosis greater. Dr. Otis Brawley, a professor at Johns Hopkins and former chief medical officer of the American Cancer Society, has argued that screening should be targeted to the highest-risk individuals — those with 30 or more pack-years and a family history — rather than offered broadly. “We are not good at identifying who really benefits,” Brawley said in a 2023 commentary. “A one-size-fits-all approach may cause more harm than good.”

Other experts counter that the CMS cut was too blunt an instrument. “If the goal was to reduce overuse among low-risk patients, you could have done that through better referral guidelines, not by slashing reimbursement for everyone,” said Dr. David Yankelevitz, a radiologist at Mount Sinai and a principal investigator in the NLST. “This was a budget-driven decision, not an evidence-driven one.”

The disagreement extends to the economic modeling. CMS used a cost-per-QALY threshold of roughly US$ 100,000, which is common in health-technology assessments but not an official US standard. Critics argue that the model undervalued the benefits of early detection, particularly when considering the costs of treating advanced lung cancer, which can exceed US$ 150,000 per patient. “The downstream costs of late-stage disease are enormous,” said Dr. Bruce Pyenson, a consulting actuary who has studied cancer screening economics. “If you account for those, the cut looks short-sighted.”

Impact on Stage at Diagnosis

One of the most concerning consequences of reduced screening is a potential shift toward later-stage diagnosis. Lung cancer stage at diagnosis is the strongest predictor of survival: patients diagnosed at stage I have a five-year survival rate of about 60%, while those diagnosed at stage IV have a rate of roughly 6%. Screening is designed to detect cancer before symptoms appear, when it is still localized.

Early data from a handful of large health systems suggest that the proportion of screen-detected lung cancers dropped by about 18% in the first half of 2024 compared to the same period in 2023. If this trend continues, the number of patients presenting with stage III or IV disease is likely to rise. A modeling study published in the Journal of Thoracic Oncology in early 2025 estimated that a sustained 20% reduction in screening could lead to roughly 1,200 additional lung cancer deaths over five years.

Real-world data are still emerging, and it may take two to three years to see a clear signal in population-based cancer registries. But early indicators are troubling. At the University of Texas MD Anderson Cancer Center, the proportion of new lung cancer patients diagnosed at stage I fell from 38% in 2023 to 33% in the first quarter of 2025, a drop that clinicians attribute in part to reduced screening access.

The impact is not limited to Medicare beneficiaries. Although the reimbursement cut directly affects only Medicare, private insurers often follow CMS’s lead. Several large insurers have already signaled that they may adjust their own payment rates, potentially reducing screening access for younger high-risk populations as well. “This could be the beginning of a broader erosion of screening coverage,” warned Dr. Michael Gould, a pulmonologist at Kaiser Permanente Southern California and a member of the USPSTF. “We need to watch this closely.”

Comparisons to Other Cancer Screening Cuts

This is not the first time CMS has reduced reimbursement for a cancer screening test. In 2011, Medicare cut payments for screening colonoscopy, leading to a temporary decline in utilization. Similarly, changes to mammography reimbursement in the 2010s were followed by modest dips in screening rates. In both cases, utilization eventually recovered, but the dips were associated with delayed diagnoses and shifts toward later-stage disease.

Lung cancer screening, however, faces unique challenges. Unlike breast or colorectal cancer, lung cancer carries a strong stigma due to its association with smoking. Patients may be less likely to advocate for themselves, and policymakers may be less sympathetic to funding a screening program for a disease perceived as preventable through behavioral change. “There is an implicit bias that lung cancer patients brought it on themselves,” said Dr. Narjust Florez, a thoracic oncologist at Dana-Farber Cancer Institute. “That bias affects funding priorities.”

Political advocacy for lung cancer screening is also less robust than for other cancers. Organizations such as the American Lung Association and the GO2 Foundation for Lung Cancer have worked to raise awareness, but they lack the resources of the breast and colon cancer advocacy communities. The reimbursement cut has galvanized these groups, but it remains to be seen whether they can reverse the policy.

A related article on this site, asthma action plans underused, illustrates a similar dynamic: well-intentioned guidelines that fail to translate into practice when reimbursement and infrastructure are lacking. The same pattern may be unfolding for lung cancer screening.

Potential Mitigation Strategies

As the effects of the reimbursement cut become clearer, several actions could mitigate the damage. First, clinicians should monitor SEER data for stage shifts and mortality trends. If a rise in advanced-stage diagnoses is confirmed, the case for restoring reimbursement will strengthen. Second, policymakers could consider risk-based rather than age-based eligibility criteria, focusing resources on those at highest risk — such as individuals with 30 or more pack-years and a family history — to maximize the benefit per dollar spent.

Bundled payment models, where a single payment covers the entire screening episode including follow-up, could also help. The UK's regional formulary restrictions offer a cautionary tale: when payment models are fragmented, access suffers. A bundled approach might align incentives for providers to perform high-quality screening while controlling costs.

Patient navigation programs have been shown to improve screening uptake in underserved populations. These programs, which help patients schedule appointments, understand results, and follow up on abnormal findings, could offset some of the access barriers created by the reimbursement cut. However, they require funding that is often scarce.

Finally, the CMS should revisit its cost-effectiveness analysis with updated inputs. Since the cut, new data from the NELSON trial have reinforced the mortality benefit of screening, and real-world evidence from the Veterans Health Administration shows that screening can be implemented with low false-positive rates. A re-evaluation might yield a different conclusion about the appropriate reimbursement level. “We need to base policy on the best available evidence, not on budget targets,” said Dr. Caroline Chiles, a radiologist at Wake Forest Baptist Health and a member of the American College of Radiology’s Lung Cancer Screening Committee. “Otherwise, we risk losing ground in the fight against lung cancer.”