The Centers for Medicare and Medicaid Services (CMS) denied an April reconsideration request by the American College of Radiology® (ACR®) and five patient advocacy groups to expand Medicare coverage for National Coverage Determination (NCD) 210.3 for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer.
CMS indicated that the additional evidence that was submitted is insufficient to support a reconsideration as it would not change the existing NCD.
The ACR and the patient advocacy groups contend ample clinical evidence was provided to support coverage of this valuable preventive screening service. For more than a decade, Medicare beneficiaries have been denied access to CTC, while private payers and Medicaid expansion states have extended coverage after updates to the U.S. Preventive Services Taskforce (USPSTF) recommendation for colorectal cancer screening. The USPSTF endorsed CTC as a colorectal cancer screening option and expanded screening for colorectal cancer in all adults ages 45 to 75 years. 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 age.
The ACR has a meeting scheduled in July with the CMS Coverage and Analysis Group to discuss its rationale and final decision.
If you have questions about Medicare coverage processes, please contact Alicia Blakey, ACR Principal Economic Policy Analyst.