Medicare Won't Cover CT Colonography

On February 11, 2009 the Centers for Medicare and Medicaid Services (CMS) issued a proposed national coverage decision memorandum not to pay for computed tomographic colonography (so-called virtual colonoscopy) to screen for colorectal cancer.

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.

The national coverage decision will not be final until 30 days after February 11 to allow for public comments.  Individuals and organizations concerned about the proposed decision can submit a comment online. However, CMS does not now cover screening CT colonography.

IMPORTANT: If you want to submit a comment to CMS online, you MUST click on and open the CMS PHI Posting Policy and then check off that you have read it.  If you don’t click on the underlined link, you cannot enter a check mark, your personal information, or your comment.

The decision was based on a review of medical literature, information presented during a meeting of MEDCAC (Medicare Evidence Development and Coverage Advisory Committee) in November, and public comments submitted since May.

In March of 2008, the American Cancer Society in collaboration with the US Multi-Society Task Force on Colorectal Cancer and the American College of Radiology, included CT colonography in its updated colorectal cancer screening guidelines.

However, in October, the US Preventive Services Task Force  (USPSTF) found insufficent evidence to add CT colonography to their colorectal cancer screening guidelines.  They were also concerned about lifetime radiation exposure and the ability of CT colonography to find problems outside the colon that needed further, perhaps unnecessary, medical testing.

The results of a randomized national study of CT colonography were published in the New England Journal of Medicine in September 2008 showing no difference between optical colonoscopy and CTC in finding large polyps, uncovering 90 percent of those over 10 millimeters.  CTC was less sensitive for intermediate-sized lesions, finding 78 percent of them.

Based on the revised ACS guidelines and C3’s policy that reimbursement should include all ACS recommended screening tests, C3: Colorectal Cancer Coalition submitted comments  in June 2008 calling for Medicare payment for CT colonography during the comment period for the National Coverage Analysis on Computed Tomography Colonography.

Medicare should provide coverage for CTC that is consistent with all colorectal cancer screening tests recommended by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Their recommendation includes tests such as fecal occult blood tests (FOBTs), barium enemas, flexible sigmoidoscopy and colonoscopy which are already covered under Medicare.

During the initial comment period in May and June of 2008, CMS received 100 comments. Of the 100, 79 supported payment for CT colonography, 20 opposed it, and 1 commentor offered no opinion.  While many comments came from professional societies and medical professionals, one-third (34) were submitted by the general public including patients, screening candidates, their families and other people with an interest in the prevention and early detection of colorectal cancer.  Of those, 32 supported paying for CTC, 1 opposed it, and 1 person offered no opinion.  A full discussion of the content of those comments is part of the material supporting the proposed coverage decision.

Medicare now covers colorectal cancer screening for beneficiaries over 50 with fecal occult blood testing, flexible sigmoidoscopy, barium enema, and colonoscopy.  There is no minimum age for screening colonoscopy.

Since Medicare began providing full coverage of screening colonoscopies in 2001, there has been a significant increase in the rates of screening colonoscopies for people covered by Medicare.  There are also been an increase in the percentage of Medicare patients whose cancer was detected at an early, highly curable stage I.

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