April 06, 2022

ACR Requests Help From HHS to Expand Medicare Coverage for CTC

The American College of Radiology® (ACR®) asked Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS), to exercise his authority under the Balanced Budget Act of 1997 (SEC. 4104 (a)(1)(D)) to deem CT Colonography (CTC), also known as virtual colonoscopy (VC), as a covered colorectal screening service under Medicare.

CTC is an approved screening test by the U.S. Preventive Services Taskforce (USPSTF) and American Cancer Society (ACS). It is covered by a majority of major private insurers, with mandated private payer coverage in 37 states and the District of Columbia. In spite of the widespread acknowledgment of CTC as an effective screening tool for colon cancer, it remains the only USPSTF- and ACS-recommended test not covered by Medicare.

Since 2009, the ACR has requested the CMS Coverage and Analysis Group to include CTC as a covered exam for colorectal cancer screening for Medicare beneficiaries several times, but our request has not been accepted. A formal reconsideration request was recently submitted to present new supporting evidence and reflect our ongoing concerns.

With the submission of this request, the ACR is hopeful HHS leadership will acknowledge the value of giving Medicare beneficiaries further freedom of choice with their colon cancer screening options and approve coverage of CTC. Its coverage will ultimately help save lives from this preventable malignancy.

If you have questions or would like more information about ACR colon cancer screening resources and activities, contact Alicia Blakey, ACR Principal Economic Policy Analyst.