ACR Urges CMS to Reconsider Non-Coverage of Computed Tomography Colonography (CTC)

When it comes to colorectal cancer (CRC), the average age at the time of diagnosis is 68 for men and 72 for women.¹ However, computed tomography colonography (CTC), a non-invasive screening test with a variety of benefits for patients and physicians, is not covered by Medicare.

With this in mind, the American College of Radiology (ACR) and five patient advocacy groups, including the Colon Cancer Coalition, the Colorectal Cancer Alliance and the Black Women’s Health Imperative, submitted a formal request on April 5 to the Centers for Medicare and Medicaid Services (CMS) to reconsider a May 2009 National Coverage Decision (NCD) to not cover CTC for colorectal cancer screening.²

In the request to the CMS, the ACR noted the May 2021 grade A recommendation from the United States Preventive Services Task Force (USPSTF) for colorectal cancer screening for people between the ages of 50 and 75, and its accompanying recommendation of CTC as having sufficient evidence to detect colorectal cancer and adenomas with “reasonable accuracy.”

The ACR emphasized that “CTC is the only USPSTF- and American Cancer Society-recommended test to not be covered by Medicare or traditional Medicaid for primary screening.”³

In a recent video interview with Diagnostic Imaging, Syam Reddy, MD, pointed out that CTC has comparable detection rates to conventional colonoscopy but offers patients practical benefits such as no sedation and milder preparation prior to the procedure. The ACR concurred, noting that the practical benefits of the non-invasive CTC can go a long way toward mitigating health care inequities with CRC screening.

“The need for a driver or car transportation, the need to take a day off from work, and the need for anesthesia or sedation for someone with a fear based in cultural background are all important barriers to screening that may be faced by someone outside of the majority,” noted the ACR in its request to the CMS. “The opportunity for prevention through a direct visualization test should not be off the table of options. Lack of Medicare and Medicaid coverage for CTC is a contributor to inequities in healthcare for colorectal cancer screening.”³

Pointing to a delay of over 18,000 CRC screenings from 2020 to 2021 due to the COVID-19 pandemic, the ACR said CRC screening rates remain sluggish without a return to pre-pandemic levels.³ With considerable monthly screening deficits for CRC being reported by accredited programs in the U.S. and the recent USPSTF recommendation to begin CRC screening at age 45, the ACR emphasized the urgency of Medicare and Medicaid coverage for CTC.

References

1. American Society of Clinical Oncology (ASC0). Colorectal cancer: risk factors and prevention. Cancer.Net. Available at https://www.cancer.net/cancer-types/colorectal-cancer/risk-factors-and-prevention. Accessed April 7, 2022.

2. American College of Radiology. Physician and patient groups urge CMS to update Medicare CTC coverage. Available at: https://www.acr.org/Advocacy-and-Economics/Advocacy-News/Advocacy-News-Issues/In-the-April-9-2022-Issue/Physician-and-Patient-Groups-Urge-CMS-to-Update-Medicare-CTC-Coverage . Published April 6, 2022. Accessed April 7, 2022.

3. Available at: https://www.acr.org/-/media/ACR/Files/Advocacy/AIA/CTC-NCD-reconsideration-request-April-2022Final-44.pdf