LCS Eligibility Tool — CHEST Bridging Specialties™
CHEST Bridging Specialties™ · LCS AFP

Lung Cancer Screening Eligibility Tool

Verified criteria: CHEST 2021 · USPSTF 2021 · NCCN v1.2026 · ACS 2023 · CMS NCD 210.14

Verified criteria 5 output states Self-contained · No external calls

Patient Information

(packs per day) × (years smoked) — or enter directly below
packs / day
×
years smoked
= Pack-years:
✓
Eligible for Annual LCS
Meets USPSTF 2021 & CHEST 2021 criteria — covered at $0 with documented SDM
GuidelineEligible?Coverage
USPSTF 2021✓$0 with documented SDM · ACA §2713
CHEST 2021✓Aligns with USPSTF coverage
ACS 2023✓No quit-year restriction
NCCN v1.2026✓Category A
Medicare (CMS NCD)✓Covered ages 50–77
Next steps Conduct and document SDM session (covers 6 required elements). Order LDCT: CPT 71271 · ICD-10 Z87.891 + Z12.2. ACR-accredited facility only. Do NOT order "standard CT chest."
◐
Eligible under ACS 2023 — Coverage Gap
Quit >15 years ago: ACS/NCCN qualify; USPSTF does not → payer may not cover
GuidelineEligible?Note
USPSTF 2021✗Quit >15 yrs exceeds cutoff
CHEST 2021✗Same cutoff as USPSTF
ACS 2023✓No quit-year restriction
NCCN v1.2026✓No quit-year restriction
Medicare (CMS NCD)✗USPSTF governs coverage
Clinical guidance This patient is clinically eligible per ACS 2023 and NCCN v1.2026 but may lack insurance coverage under USPSTF-based payer policies. Discuss in SDM. Consider PLCOm2012 risk modeling to support the case. Document thoroughly.
⚑
Eligible under NCCN Group 2 (Expanded)
Does not fully meet USPSTF — additional risk factors support screening via NCCN v1.2026
GuidelineEligible?Note
USPSTF 2021✗Does not meet all three criteria
CHEST 2021✗Aligns with USPSTF
ACS 2023~Depends on specific criteria
NCCN v1.2026✓Group 2: ≥20-yr smoking + ≥1 risk factor
Medicare (CMS NCD)✗USPSTF governs Medicare coverage
Clinical guidance Consider PLCOm2012 risk model (≥1.5% = supports eligibility). Apply NCCN Group 2 criteria in SDM conversation. Payer coverage may not follow NCCN — verify before ordering. Document risk discussion thoroughly.
!
Borderline — Individualized SDM Recommended
Patient approaches eligibility thresholds; shared decision-making indicated
Clinical guidance This patient does not currently meet standard eligibility criteria but has risk factors warranting discussion. Consider PLCOm2012 model, occupational and family history assessment, and individualized SDM — especially for ages 45–49 with significant smoking history and additional risk factors (African American race, COPD, occupational or family exposure).
✗
Not Currently Eligible for Routine LCS
Does not meet criteria under any major guideline at this time
USPSTF 2021
Ineligible
CHEST 2021
Ineligible
ACS 2023
Ineligible
NCCN v1.2026
Ineligible
Continue tobacco cessation counseling Document smoking history and reassess eligibility annually. If risk factors develop (COPD, family history, occupational exposure), reassess using NCCN Group 2 criteria.
CHEST Bridging Specialties™ · LCS AFP · Lung Cancer Screening Eligibility Tool
Sources: USPSTF 2021 · CHEST 2021 · ACS 2023 · NCCN v1.2026 · CMS NCD 210.14
For educational use only. Not a substitute for clinical judgment.