CMS commences national coverage analysis for CT colonography

The Centers for Medicare and Medicaid Services is now accepting public comments on national coverage for CT colonography. Comments will be accepted through June 18, 2008, at the CMS web site.Currently, Medicare does not list CTC as a possible coverage option under the colorectal cancer screening benefit. But the inclusion of CTC in the American Cancer Society's recently revised cancer screening guidelines gave the modality a major boost. "This is definitely progress toward developing a means for CMS to cover CTC for screening," said Dr. Judy Yee. She cited the ACS recommendations as well as the results of the American College of Radiology Imaging Network 6664 trial for giving the modality its momentum toward wider reimbursement. "The results of (ACRIN 6664) basically showed that CTC has 90% sensitivity for polyps 9 mm and larger, which is similar to optical colonoscopy and better than other currently accepted and covered screening tests such as fecal occult blood test, flexible sigmoidoscopy, and barium enema," said Yee, vice chair of radiology at the University of California, San Francisco. She added that CTC scored another point when the ACS guidelines specifically delineated it as a test that can detect polyps and cancer. With regard to public comments, the CMS reviewers are particularly interested in clinical studies and other scientific information related to CTC. "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," said the CMS website.

Yee recommended that the following studies are worth bringing to the attention of the CMS reviewers:

• Levin B, Lieberman, DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps. 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134(5):1570-1595.
• Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. NEJM 2007;357(14):1403-1412.
• Glick SG, Johnson CD, Macari M, Yee J. ACR practice guideline for the performance of computed tomography (CT) colonography in adults, ACR Practice Guidelines and Technical Standards 2005-2006.

The CMS decision memo on CTC screening coverage is scheduled for release on Nov. 11, 2008, while the expected national coverage analysis completion date is Feb. 17, 2009.

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to submit public comments.For more information from the Diagnostic Imaging archives:

CT colonography experts plan for growing demand

CT colonography experts assess new screening guidelines

American Cancer Society blesses virtual colonoscopy for screening

CTC pushes for rightful place in colorectal cancer screening