ACR urges Medicare payment for CT colonography

ACR urges Medicare payment for CT colonography

By staff writers

August 15, 2016 — The American College of Radiology (ACR) has issued a statement urging the U.S. Centers for Medicare and Medicaid Services (CMS) to approve reimbursement of CT colonography for senior citizens.

The August 15 statement requests that CMS open a national coverage determination (NCD), a major step toward a ruling that a particular medical procedure should be covered on a national basis. Without an NCD in place, coverage decisions can be made at the discretion of local Medicare contractors.

The U.S. Preventive Services Task Force (USPSTF) in June gave an “A” grade to colorectal cancer screening, the group’s highest grade, and included CT colonography among its approved screening strategies, the ACR noted. The organization further pointed out that under the Affordable Care Act, an A rating from the USPSTF requires payors participating in insurance exchanges to cover CT colonography, also known as virtual colonoscopy, without co-payments from patients.

The ACR and various colon cancer awareness groups believe that CT colonography has been proved comparable in effectiveness to other colon strategies such as optical colonoscopy, and its noninvasive nature could encourage many individuals who have been avoiding screening to get exams. One study showed that using CT colonography to screen Medicare patients would save 29% of costs and save Medicare up to $1.7 billion per screening cycle, the ACR said.