December 09, 2016

CMS Defers Reconsideration of CTC Coverage

The Centers for Medicare & Medicaid Services (CMS) has decided to defer reconsideration of its 2009 Medicare national non-coverage determination (NCD) for CT colonography (CTC—also known as virtual colonoscopy). The decision followed a formal request for reconsideration submitted to CMS in August by the CT Colonography Coalition, which includes the American College of Radiology (ACR) and major colorectal cancer care advocacy groups.

The coalition has scheduled a meeting with CMS to gather information about the reasons for deferring reconsideration. It plans to follow up with additional meetings to address specific concerns raised by the agency.

CTC is recommended as an effective colorectal cancer screening exam by the U.S. Preventive Services Task Force, the ACR, American Cancer Society, FDA, U.S. Multi-Society Task Force and many major commercial payers, such as UnitedHealthcare, Cigna, Blue Cross-Blue Shield insurers and Kaiser Permanente. Laws in 33 states and the District of Columbia mandate CTC insurance coverage. However, Medicare has yet to re-open its 2009 non-coverage determination that denies this cancer screening exam to its beneficiaries.

The ACR, Colon Cancer Alliance, Colon Cancer Coalition, Prevent Cancer Foundation and other stakeholders are committed to advocating for increasing the colorectal cancer screening rate with screening options that include CTC. We remain vigilant and will continue to urge CMS to do the right thing to expand Medicare coverage for this recognized life-saving screening exam.