Bill Would Require Medicare to Cover Virtual Colonoscopy

By Sara Michael

Legislation introduced this week would require Medicare to cover virtual colonoscopy for colon cancer screening.

Reps. Danny Davis (D, Ill.) and Ralph Hall (R, Texas) introduced the CT Colonography Screening for Colorectal Cancer Act of 2012, or H.R. 4165, which requires CMS to reimburse for CT colonography, also known as virtual colonoscopy.

The bill, which was also unsuccessfully introduced two years ago, comes on the heels of new research showing CTC’s efficacy in seniors.

More than have of the states mandate insurance coverage for colorectal cancer screenings, but these tests are not required to be covered on a national level, according to the Medical Imaging and Technology Alliance, which supports the legislation.

Therefore, this screening is not being adequately used, the alliance said.

Requiring CMS to cover CT colonography would “eliminate unnecessary barriers,” MITA said, adding, “Data show that access to virtual colonography increases compliance in patients who otherwise would avoid a screening that saves lives.”

CT conolography is just as accurate as standard colonoscopies in detecting cancers and precancerous polyps in people over 65, according to the largest multi-center study on the topic, which was published recently in Radiology.

The findings supported an earlier study that determined its effectivenss in adults over 50.

Last month, the Colon Cancer Alliance and the American College of Radiology called on Medicare to expand coverage for CT colonography, citing this new data.

“The minimal invasiveness and lower cost of CT colonography can attract more seniors to be screened if Medicare will cover them for the exam.

Many seniors, who might not get tested otherwise, can’t afford the added cost of paying for the exam themselves and may ultimately pay with their lives if Medicare does not provide coverage,” Andrew Spiegel, Colon Cancer Alliance CEO, said in a statement.

Some large insurance companies, including CIGNA, UnitedHealthcare, Anthem Blue Cross Blue Sheild, cover virtual colonoscopy, according to the ACR.