CT Virtual Colonoscopy May Get a Second Chance for Medicare Reimbursement

The last time the FDA reviewed CT virtual colonoscopy (CTC) as a screening tool was in the fall of 2013. Now, CTC is getting a ”second look” at reimbursement with the help of unanimous approval from the FDA Gastroenterology-Urology Devices Panel, which said CTC is “extremely safe and effective.” CMS has approved Medicare reimbursement of a stool DNA colorectal cancer screening test but has continued to hold back on CTC. Because of this, the American College of Radiology (ACR) drafted a letter arguing that CTC’s proven performance has exceeded the basic six standards applied to the stool DNA testing.

Clinical Data Behind CTC is Positive

6.23.15

The ACR and the ACR Imaging Network (ACRIN) has been documenting the significance of CTC since 2008. Professional organizations have lobbied and advised Medicare to reimburse for CT colonoscopy for many years. Private insurance providers, such as CIGNA and Anthem Blue Cross Blue Shield, already cover CTC, believing it to be a highly viable screening tool for adenomatous polyps. Additionally, ACRIN has reported that CTC is comparable to endoscopic colonoscopy, the current standard of care. CTC cost varies from $2,010 to $3,764 and has an average cost of $3,081.

The ACR also reported that CTC is not only minimally invasive, but also a leading-edge technology that can evaluate the entire colorectal area, provide 3-D imaging techniques and allow a thorough exam without patient sedation. It is believed that, with CTC reimbursement, more patients would have screening exams, especially for colorectal cancer. This likely would result in earlier cancer detection and possibly prevention of the disease. Earlier treatment could reduce the number of deaths from colorectal cancer.

CTC Faces Challenges Outside Medicare Reimbursement

A factor that may hinder the adoption of CTC is lack of awareness. Primary care physicians continue to be late in the adoption of new tests and techniques. There also continues to be the power struggle of which physician performs the test and receives reimbursement, which can be and likely is another negative factor to improve patient care and lower patient costs.

Additionally, endoscopic colonoscopy has its advantages, as one can have the endoscopy with one bowel prep, and polyps can be removed via biopsies during the procedure. A positive CTC means patient must take a second bowel prep and undergo an endoscopic procedure to remove the polyps. This requires the patient to have two preps and two procedures versus one. However, a study by Allan S. Brett, M.D., professor of clinical internal medicine at Medical University of South Carolina School of Medicine found that CTC has become the most common practice-screening tool with endoscopic colorectal cancer.

In 2008, the U.S. Preventive Services Task Force (USPSTF) gave CTC as a screening tool the grade of “I,” or insufficient evidence. If the USPSTF gives CTC an A or B rating, it’s probably that CTC could become a screening tool and be reimbursed by Medicare.

Loretta Loncoske, BS, R.T. (R)
ABOUT THIS EXPERT
Loretta Loncoske, BS, R.T. (R), Clinical Analyst — Ms. Loncoske joined MD Buyline in 1991 with over 30 years of clinical experience in the high-end radiology modalities of MRI, CT, nuclear medicine, PET and interventional radiology. She received her degree in business management from the University of Maryland and graduated with honors from the University of Wisconsin, receiving a Bachelor of Science in business administration and computer science. She is a Registered Radiologic Technologist and member of the American Society of Radiologic Technologists and Healthcare Information and Management Systems Society.