ACR Calls for Coverage of CT Colonography

The evidence standard that the Centers for Medicare & Medicaid Services (CMS) used to approve Medicare coverage of a stool DNA colorectal cancer screening test should be applied to CT colonography (virtual colonoscopy) and other colorectal cancer screening exams, according to the ACR. In a new letter to the CMS, the ACR urged that coverage criteria be transparent and consistently applied.

Studies show that virtual colonoscopy detects colorectal cancer and precancerous polyps far better than the stool DNA test, is more cost-effective, and results in fewer false-positive exams, which can reduce downstream costs and patient anxiety. CT colonography is recommended every five years while the DNA test would be done every three years. This less frequent testing may further lower costs and attract more people to be screened.

“CT colonography is an American Cancer Society–recommended screening test. The exam’s performance far exceeds the standard applied to the DNA test. Transparent evidence-based approval and the need for more screening options for the nation’s second leading cancer killer require that Medicare cover beneficiaries for CT colonography,” says Judy Yee, MD, chair of the ACR Colon Cancer Committee.
CT colonography is less invasive and costly than colonoscopy. Sedation is not required. Afterward, patients can go back to their daily activities. National Institutes of Health researchers found that the benefits of virtual colonoscopy clearly outweigh any low radiation risk.

Because CT colonography scans the entire abdomen, it can spot cancers and other serious illnesses, including abdominal aortic aneurysms, in organs other than the colon. This can lead to early diagnosis and treatment of previously undetected problems and save even more lives.

Studies in the New England Journal of Medicine and Radiology confirm CT colonography is comparably accurate to standard colonoscopy—including in patients aged 65 and older. Studies at National Military Medical Centers in Bethesda, Maryland, and San Diego show that CT colonography availability significantly boosts colorectal cancer screening rates.

CIGNA, UnitedHealthcare, UniCare, Anthem Blue Cross and Blue Shield, and other major insurers already cover screening CT colonography. More than 20 states require coverage of CT colonography. Yet Medicare does not currently cover beneficiaries for the exam.