August 15, 2018

BCBS of South Carolina to Cover Screening CT Colonography

Blue Cross Blue Shield (BCBS) of South Carolina is now among the growing list of private insurance companies that cover CT Colonography (CTC or Virtual Colonoscopy) for screening colorectal cancer. As recently as last year, BCBS considered CTC a diagnostic test only. The BCBS Colorectal Cancer Screening Medical Policy was updated August 9, 2018.

The Medical Policy states, based on our criteria and assessment of the peer-reviewed literature, including the National Comprehensive Cancer Network (NCCN) and the United States Preventative Services Task Force (USPSTF), virtual colonoscopy (CT colonography) is among the list of colorectal cancer screening modalities that are considered medically necessary for men and women 50 years or older, who are average risk for colon cancer.

Of note, the new 2018 American Cancer Society (ACS)Guidelines recommends that colorectal cancer screening start earlier at age 45 recognizing the significant increase in early age onset colorectal cancers.

This policy update is directly in line with the United States Preventive Services Task Force (USPSTF) decision to assign a grade of “A” to CT colonography as a screening modality for the detection of colon cancer.

This decision, according to provisions included in the Affordable Care Act, mandates coverage by private insurance companies participating in the insurance exchange program. Many large insurers, including CIGNA, AETNA and UnitedHealthcare, cover screening CTC irrespective of ACA requirements.

Medicare does not currently cover CT colonography, but the ACR continues to work with stakeholders, including patient advocacy groups, to reopen the Centers for Medicare and Medicaid Services National Coverage Determination. A special Congressional Briefing on CT colonography will take place in Washington, DC on Wednesday September 12, 2018, provided by CTC leaders.

Colorectal cancer is the second leading cause of cancer death when numbers for both men and women are combined. The death rate (the number of deaths per 100,000 people per year) of colorectal cancer has been dropping for several decades. One reason for this is that today colorectal polyps are more often found by screening and removed before they can develop into cancers.

The ACR remains committed to helping reduce colorectal cancer by expanding screening coverage and access for individuals at average risk for developing colorectal cancer, regardless of payer.