Medicare instructs contractors to begin covering CT colorectal cancer screening
The Medicare program recently instructed its administrative contractors to begin covering CT-based colorectal cancer screening retroactive to Jan. 1, ending years of radiology advocacy on this issue.
CMS made the notice in a Change Request Transmittal sent March 20, emphasizing that all coinsurance and deductibles should be waived for the exam. Medicare Administrative Contractors now have until July 1 to implement the change, with 74263 the newly covered CPT code.
The feds first proposed paying for “virtual colonography”—a colonoscopy alternative that offers high accuracy without the need for sedation—in July. Radiology advocates have long lobbied for this payment update and celebrated the news last year.
“American College of Radiology members are encouraged to offer the CTC screening test to all patients who can benefit from early detection of colorectal cancer,” ACR said in a news update published April 3. “Previously, this was a noncovered service for the Medicare population that led to a lack of access for this vulnerable population.”
The Centers for Medicare & Medicaid Services typically issues these national coverage determinations on a quarterly basis, ACR noted. It’s also soon expected to release educational materials including coding and reimbursement details. The college urged organizations to contact their MAC to clarify billing requirements around CT colorectal cancer screening.
In January, ACR also launched a radio public service announcement campaign to help inform Medicare beneficiaries that this service is now covered. Colorectal cancer is the leading cancer killer for men under 50 and No. 2 for women of this age but can be stopped if caught through screening, ACR noted in a separate blog post.
The college plans to host an in-person course to educate radiologists about the technique, performance and interpretation of CTC. This would include the supervised review of at least 50 cases, with attendees able to earn CME credits for participating.
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.