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CMS Says CT Colonography Evidence Insufficient: Medicare Won't Cover It

The Centers for Medicare and Medicaid issued a final National Coverage Decision on May 12, 2009 denying Medicare payments for CT colonography (virtual colonoscopy) to screen for colorectal cancer.

Despite an overwhelming number of comments urging that CMS overturn their provisional determination not to cover the test, the agency remained unconvinced that there was sufficient evidence to conclude that CT colonography was appropriate to screen for colorectal cancer.

Almost 95 percent of 357 comments supported CT colonography screening, including comments from the American Cancer Society and C3:Colorectal Cancer Coalition.

Briefly,

The Centers for Medicare and Medicaid Services (CMS) concludes the following:

The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under § 1861(pp)(1) of the Social Security Act.  CT colonography for colorectal cancer screening remains noncovered.

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3 Comments

  1. Michelle G. said:

    CMS please reconsider this and fund CT colonography. Colorectal cancer is treatable when detected early. The problem is that too often it is not detected until it is quite advanced. Colorectal is the second biggest cancer killer after lung cancer. We need to do EVERYTHING we can to detect colorectal cancer at its earliest stages. Traditional colonoscopy comes with risks of perforation of the bowel as well and is very uncomfortable so many patients are still reluctant to undergo this form of diagnostic testing. I speak from my heart as my husband was diagnosed with stage IV colorectal cancer at the young age of 38. Michelle

  2. Judy C. Owens said:

    I desperately urge you to reconsider. I am overdue for a checkup on my colon and am trying to get in with a close by hospital that provides the MRI — and I have a health reason. Due to heart problems and stents — I am on Plavix — to have a regular colonoscopy I would have to go off of the plavix for a week prior. Even my Colon doctor doesn’t want me to do that as he too has stents and takes plavix and thinks the danger of stopping plavix is too great. HELP

  3. Kate Murphy said:

    Judy,

    Since you are not going for a screening colonoscopy but one to follow-up your colon cancer diagnosis, CT colonography may be covered. The CMS decision covered screening CT colonography but I believe that Medicare does cover colonography for other reasons.

    Check with the radiologists who do this testing in your area.

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