CMS Proposes No Medicare Coverage for Virtual Colonoscopy

Under a proposed decision memorandum issued on February 11 by the Centers for Medicare and Medicaid Services (CMS), virtual colonoscopy—also known as CT colonography—for colorectal cancer screening would not be covered by Medicare. In the memo, CMS said the “evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test” to be covered for Medicare beneficiaries.

The decision by CMS, which is open for public comment until March 11, is in line with recommendations published last October by the U.S. Preventive Services Task Force. It conflicts, however, with the conclusions of the American Cancer Society, from which updated guidelines on colorectal cancer screening were issued that include virtual colonoscopy as an acceptable screening test alongside options like a standard optical colonoscopy and flexible sigmoidoscopy.

The study results published to date, including those from the NCI-funded ACRIN 6664, indicate that for detecting polyps sized 10 mm or larger, virtual colonoscopy and standard optical colonoscopy are equally effective. For polyps 6 mm or less, there is some controversy about the cancer risk they pose, and the agency noted that the data indicate virtual colonoscopy is less reliable than standard colonoscopy for detecting these smaller polyps. There is also some debate about whether virtual colonoscopy misses depressed or “flat” polyps.

Virtual colonoscopy may be considered cost effective at specific reimbursement rates, CMS noted in the decision memo. However, it also states: “A pivotal, overarching concern is the generalizability of these main study results to the Medicare population. The mean age of participants in these studies…was considerably younger than the Medicare aged population.”