CMS declines to revisit CT colonography coverage

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In a stunning year-end setback for screening CT colonography, the U.S. Centers for Medicare and Medicaid Services (CMS) has turned down a request by advocates for CT colonography to reconsider its 2009 decision not to pay for the imaging-based colon cancer screening exam.

The American College of Radiology (ACR) said it has been informed by CMS that the agency would not be reopening the coverage review. A CMS spokesperson confirmed the decision with but added that the agency can decide to initiate the reconsideration process at any time.

The decision is a serious blow to the CT Colonography Coalition, a group that includes the ACR and several major colorectal cancer screening advocacy groups. The coalition had submitted a formal request to CMS for review in August, after the U.S. Preventive Services Task Force (USPSTF) included CT colonography (CTC) among the colon cancer screening tests that it recommended, giving the exam an "A" rating earlier this year.

"The Centers for Medicare and Medicaid Services' decision not to re-examine Medicare coverage for CT colonography is out of step with modern medicine and the needs of America's seniors," said Dr. Judy Yee in a statement released today by the ACR. Yee heads the ACR's colorectal cancer working group and serves as chief of radiology at the San Francisco Veterans Affairs Medical Center. "Abundant efficacy and cost-effectiveness evidence demonstrates that CTC (also known as virtual colonoscopy) is a front-line colorectal cancer screening tool."

With its June 2016 approval of CTC for screening, the USPSTF joined a broad range of healthcare and colorectal cancer care advocacy groups supporting the exam, including the ACR, American Cancer Society, U.S. Food and Drug Administration, and U.S. Multi-Society Task Force, as well as several commercial payors such as UnitedHealthcare, Cigna, Blue Cross/Blue Shield insurers, and Kaiser Permanente. Laws in 33 states and the District of Columbia mandate that insurers cover CTC. The Agency for Healthcare Research and Quality (AHRQ) and the National Committee for Quality Assurance (NCQA) have recognized CTC as a metric (known as the HEDIS measure) for colorectal cancer screening.

"Yet Medicare patients who need this lifesaving screening the most are denied coverage," Yee said in the ACR statement. "This must change if we are to attract the up to 40% of Americans who should be screened for [colorectal cancer], but choose not to, to get tested. Lives are being lost every day that Medicare coverage is denied."

"It's difficult to fathom how CMS arrived at this indefensible position," said Dr. Perry Pickhardt, professor of radiology at the University of Wisconsin School of Medicine & Public Health.

Representatives of the coalition and the ACR met with CMS on December 13 to discuss its reasoning for the decision, and today they vowed to keep working for approval.

"The ACR will work closely with CMS to resolve any issues that they may still have about CTC," the ACR said. "The college will also continue to work with the colorectal cancer care advocacy groups, patients, lawmakers, and other decision-makers to secure Medicare coverage for CT colonography."

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