Half of states now offer private-payor VC coverage

The U.S. Centers for Medicare and Medicaid Services (CMS) may be on the verge of denying coverage for virtual colonoscopy (also known as CT colonography, or CTC), but private payors are rushing to cover the virtual exam in unprecedented numbers.

Thanks in part to state laws mandating coverage of any colorectal cancer screening exam approved by the American Cancer Society (ACS), payors are required to cover CTC in 26 states and Washington, DC, according to a March 26 article on the American Gastroenterological Association's (AGA) Web site.

The AGA listed the following states that are required or have agreed to provide coverage for CTC due to ACS approval:

  • Alaska
  • Arkansas
  • California
  • Connecticut
  • Delaware
  • District of Columbia
  • Georgia
  • Illinois
  • Indiana
  • Louisiana
  • Maryland
  • Missouri
  • Nebraska
  • Nevada
  • New Jersey
  • New Mexico
  • North Carolina
  • Oregon
  • Rhode Island
  • Texas
  • Virginia
  • Washington
  • Washington, DC
  • West Virginia

New York, Vermont, and Wyoming do not mandate coverage of all ACS-approved cancer screening tests, but they have voluntarily agreed to include screening CTC screening in payor-mandated coverage.

The ACS-mandated state coverage is bolstered by commitments from private payors to cover screening CTC for all of their insured regardless of location. The AGA's list of insurers offering CTC as a covered benefit includes:

  • Cigna
  • CareFirst BCBS (VA, DC, MD)
  • BCBS Delaware
  • Independence Blue Cross (PA)
  • Horizon BCBS (NJ)
  • Anthem BCBS (CA, NV, CO, WI, MO, IN, KY, OH, NY, CT, VA, GA, ME, NH, NY)
  • BCBS North Carolina
  • Physicians Plus of WI
  • BCBS Rhode Island
  • BCBS Arkansas

Related Reading

VC/AAA screening combo cost-effective in older adults, March 26, 2009

Colonoscopy seen as reducing CRC mortality in Germany, March 23, 2009

ACR urges Congressional support for CT colonography, March 16, 2009

CMS rejects case for virtual colonoscopy reimbursement, February 12, 2009

Adverse events weigh on colonoscopy mortality equation, February 6, 2006

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