Ignoring its advisory panel, the Centers for Medicare and Medicaid Services (CMS) announced that annual low-dose CT lung cancer screening for high-risk individuals will be covered by Medicare. However, CMS applied restrictions that will limit access to screening, avoiding the chaotic marketplace free-for-all that would have resulted from an unrestricted approval. Medicare will pay for one lung cancer screening CT per year for beneficiaries meeting the entry criteria of the National Lung Screening Trial (NLST): aged 55-74, with at least 30 pack-years of smoking now or previously, and not having quit in the prior 15 years. In a nod to the complexity of the decision to screen or not, CMS requires the first lung cancer screening CT be ordered during what they call a "lung cancer screening counseling and shared decision-making visit" by a physician or associated midlevel provider. They seem to be requiring this be a dedicated visit, not squeezed into another appointment. Follow-up yearly screens could be done on any visit. CMS also erected a second barrier, restricting the radiology centers who will be allowed to be paid for performing and interpreting lung cancer screening CTs. Initially, only centers that were part of the original NLST or are accredited diagnostic imaging centers experienced with low-dose CT lung cancer screening will be allowed to participate. Radiology centers will also have to submit