ACR Presents Case for Medicare Coverage of CT Colonography

Members of the American College of Radiology® (ACR®) Colon Cancer Committee recently met with Dora Hughes, MD, MPH, Acting Chief Medical Officer and Acting Director of the Center for Clinical Standards and Quality (CCSQ) for the Centers for Medicare and Medicaid Services (CMS) and staff of the CMS Coverage and Analysis Group regarding Medicare coverage of CT colonography for colorectal cancer screening.

Judy Yee, MD, Chair of the Colon Cancer Committee, presented an overview of CT colonography and the benefits of the exam as a minimally invasive direct visualization test that does not require anesthesia and can prevent colorectal cancer by detection of precancerous polyps. Dr. Yee also provided a timeline of coverage efforts, beginning with the publication of the American College of Radiology Imaging Network National CT Colonography Trial in 2008; CMS denied coverage in a National Coverage Analysis process in 2009.

Since that time, many additional studies have been published and the American Cancer Society, the U.S. Preventive Services Task Force (USPSTF) and the U.S. Food and Drug Administration have all recognized and support coverage of CT colonography for colorectal cancer screening. CT colonography is the only USPSTF-approved colorectal cancer screening test not covered by Medicare.

David Kim, MD, presented an overview of the published studies proving CT colonography to be an effective screening exam for the Medicare population. Cecelia Brewington, MD, then discussed the President’s Cancer Panel and how Medicare coverage of screening CT colonography would help address disparities and increase colorectal cancer screening rates in minority populations. Dr. Brewington emphasized the advantages of a direct visualization test that does not require sedation, making it a great option for beneficiaries who have little to no paid time off work, a fear of sedation, or logistical challenges such as transportation.

CMS staff were attentive to the discussion and requested supporting documentation following the meeting. ACR will continue to engage with CMS on this issue.

For questions, contact Katie Keysor, ACR Senior Director, Economic Policy.