The American College of Radiology continues its push to convince the Centers for Medicare & Medicaid Services to cover a key CT service that saves lives.
ACR is seeking Medicare payment for computed tomography colonography, also referred to as a “virtual colonoscopy” and recently met with CMS to discuss the issue. The campaign dates to at least 2008, when the college published results from its Imaging Network National CT Colonography Trial.
The large, multicenter study showed that CTC is highly accurate for the detection of large and intermediate polyps. However, CMS opted to reject the national coverage determination in 2009.
“Since that time, many additional studies have been published and the American Cancer Society, the U.S. Preventive Services Task Force and the U.S. Food and Drug Administration have all recognized and support coverage of CT colonography for colorectal cancer screening,” ACR said in a news update published May 8. “CT colonography is the only USPSTF-approved colorectal cancer screening test not covered by Medicare.”
Members of ACR’s Colon Cancer Committee recently met with the acting director of the Center for Clinical Standards and Quality, along with other CMS staff. Radiologists presented information about the benefits of CT for colon cancer assessment, which does not require anesthesia. This makes the modality “a great option for beneficiaries who have little to no paid time off work, a fear of sedation or logistical challenges such as transportation.”
“CMS staff were attentive to the discussion and requested supporting documentation following the meeting,” ACR said in the update.
The meeting comes after the American College of Physicians last year issued updated guidance, claiming CTC should not be used to screen for colorectal cancer. USPSTF, meanwhile, in 2021 recommended dropping the screening age from 50 down to 45 while endorsing CTC as an appropriate testing method.
A study last year found that Medicare beneficiaries who reside in affluent communities are six times more likely to receive a CTC than those in low-income areas.
“It is unclear as to why CMS does not cover screening CT colonography as it does for all other guideline-recommended colorectal cancer screening strategies,” wrote study co-author Judy Yee, MD, chair of radiology at Montefiore Health System in New York, who was among those meeting with CMS recently. “Medicare coverage of screening CT colonography could lessen income-based access disparities as well as downstream colorectal cancer disparities since CTC can lead more individuals to be screened so that cancers are prevented completely or detected early.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.