CMS criticized over lack of support for CT colonography

Imaging societies and advocacy groups nearly universally decried CMS’s decision to not revisit Medicare coverage for CT colonography (CTC). CTC has endorsements from major players including the American Cancer Society, American College of Radiology (ACR) and the U.S. Food and Drug Administration.

It’s required to be insured in 33 states and Washington, D.C., and even the U.S. Preventative Services Task Force (USPSTF) gives the exam an “A” rating, prompting questions about the lack of Medicare coverage.

“The Centers for Medicare & Medicaid Services’ (CMS) decision not to re-examine Medicare coverage for CT colonography (CTC) is out of step with modern medicine and the needs of America’s seniors. Abundant efficacy and cost-effectiveness evidence demonstrates that CTC (also known as virtual colonoscopy) is a front line colorectal cancer (CRC) screening tool,” the ACR said in a statement. “Medicare patients who need this life saving screening the most are denied coverage. This must change if we are to attract the up to 40 percent of Americans who should be screened for CRC, but choose not to, to get tested. Lives are being lost every day that Medicare coverage is denied.”

While the low patient acceptance of traditional colonoscopy is a separate problem, CTC doesn’t involve a six-foot long scope in the rectum, translating to patients who are much more willing to undergo the screening.

The recent approval of a DNA stool test by CMS shows an inconsistency in the criteria used, according to the ACR.

CTC detects colorectal cancer and precancerous polyps far better than the DNA stool test, is more cost effective, and results in fewer false positive results—results that still prompt a traditional colonoscopy.

“The ACR will work closely with CMS to resolve any issues that they may still have about CTC. The College will also continue to work with the colorectal cancer care advocacy groups, patients, lawmakers and other decision makers to secure Medicare coverage for CT colonography.” said the ACR.