On May 19, the Center for Medicare and Medicaid Services (CMS) initiated a national coverage analysis (NCA) to study the impact and readiness of widespread screening in the U.S. The NCA, with a scheduled due date of November 19 and a completion date of February 19, 2009, is a crucial first step in a process that could lead to eventual reimbursement of the CT procedure by Medicare -- as well as third-party payors that tend to follow Medicare's lead.
Medicare reimbursement is currently limited to a handful of screening modalities, including optical colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, and fecal occult blood testing. The CMS is accepting public comments through June 18 on the proposed initiative to add VC coverage.
"CMS considers all public comments, and is particularly interested in clinical studies and other scientific information related to the technology under review," the agency wrote in its announcement. "We are especially interested as to the types of studies needed if the evidence is determined to be premature for coverage or if the appropriate frequency interval is uncertain."
Individuals interested in contributing to the discussion on the appropriateness of virtual colonoscopy for colorectal cancer screening are invited to visit an informational link on the CMS Web site, then post their comments here. The aim of the NCA is to evaluate the available evidence for screening VC and determine if a national coverage determination (NCD) is warranted.
On March 5 the American Cancer Society, the U.S. Multisociety Task Force on Colorectal Cancer, and the American College of Radiology issued new cancer screening guidelines, including a recommendation that virtual colonoscopy be included in the armamentarium of colon screening tests.
"Neither the Medicare law nor the regulations identify the CTC test as a possible coverage option under the colorectal cancer screening benefit," CMS explained in its May 19 announcement. "However, under 42 CFR 410.37(a)(1), CMS is allowed to use the NCD process to determine coverage of other types of colorectal cancer screening tests that are not specifically identified in the law or regulations as it determines to be appropriate, in consultation with appropriate organizations."
For now, U.S. reimbursement of VC is limited to a handful of diagnostic indications and even fewer screening indications in most states, funded through local coverage decisions by local Medicare carriers.
CMS urges submission of all public comments through its Web site, and cautions that posts containing personal health information may not be included.
Although initiation of an NCA is far from the last word on the subject, the agency's timeliness is notable, according to VC provider Dr. Perry Pickhardt, an associate professor of radiology at the University of Wisconsin-Madison.
"This shows that the revised ACS guidelines really did kick-start the national coverage process," Pickhardt told AuntMinnie.com.
By Eric Barnes
AuntMinnie.com staff writer
May 20, 2008
American Cancer Society recognizes virtual colonoscopy screening benefit, March 5, 2008
Bill introduced to add VC to Medicare screening coverage, December 20, 2007
VC CAD beats human readers in multicenter trial data, November 19, 2007
Five-modality Munich trial finds high sensitivity for OC, VC, November 12, 2007
Positive trial results boost VC's prospects for broader screening role, October 16, 2007
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