How to: Implementing Expanded Medicare CTC Coverage

The Centers for Medicare and Medicaid Services (CMS) released Change Request (CR) 13939/Transmittal 13097 to notify Medicare Administrative Contractors (MACs) of its decision to expand coverage for Colorectal Cancer Screening Tests National Coverage Determination (NCD) 210.3. CMS issues revisions to NCDs through its quarterly maintenance update of the International Classification of Diseases (ICD) 10 changes and other coding updates. This guidance instructs MACs to allow coverage for screening CT colonography (CTC) CPT code 74263, effective Jan. 1, 2025, and ensure coinsurance and deductible are waived. MACs have until July 1, to implement this policy change.

American College of Radiology® (ACR®) members are encouraged to offer the CTC screening test to all patients who can benefit from early detection of colorectal cancer. Previously, this was a non-covered service for the Medicare population that led to a lack of access for this vulnerable population. ACR provides an online resource about the benefits of CTC to help radiology patients learn more about the lifesaving test.

CMS will develop and release national provider education via an MLN Matters article that will include all applicable coding and reimbursement information. Providers and/or billing and coding staff should contact their MAC to clarify billing requirements for CTC. 

If you have questions about the final coverage decision, contact Alicia Blakey, ACR Principal Economic Policy Analyst.