April 06, 2022

Physician and Patient Groups Urge CMS to Update Medicare CTC Coverage

On April 5, The American College of Radiology® (ACR®) and five patient advocacy groups submitted a formal National Coverage Decision (NCD) reconsideration request to the Centers for Medicare and Medicaid Services (CMS) Coverage and Analysis Group (CAG) related to its May 2009 national non-coverage decision on Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CAG-00396N).

The United States Preventive Services Task Force (USPSTF) recommendation endorses CTC as a colorectal cancer screening option and expands screening for colorectal cancer in all adults ages 45 to 75 years. CTC remains the only USPSTF and American Cancer Society (ACS)-recommended test to not be covered by Medicare or traditional Medicaid for primary screening. As the Affordable Care Act requires private insurers to cover all USPSTF-approved screening services without patient cost-sharing, patients lose access to this screening option once they become Medicare eligible.

There have been pivotable events since the last appeal of the ACR to CMS to include CT colonography as a covered exam for colorectal cancer screening in Medicare beneficiaries. The NCD reconsideration request contains additional evidence, including the updated USPSTF final recommendation for colorectal cancer screeningemphasizing  the President's revitalization of the “Cancer Moonshot” initiative, and the disproportionate impact on Black patients and underserved communities.

Medicare coverage for CTC has been a top priority for the ACR throughout the last decade, as the College strives for the mutual goal of screening as many patients as possible. Making another screening option available to Medicare beneficiaries will save lives. The ACR Colon Cancer Committee, led by Judy Yee, MD, FACR, believes this is the right time to reapproach CMS to request coverage.

Our organizations request CMS conduct a National Coverage Analysis (NCA) to evaluate the available evidence for screening CTC to determine that a national coverage determination is warranted. We will provide updates to ACR members as new information becomes available.

If you have questions about Medicare coverage processes, contact Alicia Blakey, ACR Principal Economic Policy Analyst.