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The Centers for Medicare and Medicaid Services (CMS) has issued a proposed decision memo for screening CT colonography (CTC) for colorectal cancer, finding that the evidence is inadequate to conclude that it is an appropriate colorectal cancer (CRC) screening test.

"CMS does not believe that the evidence is sufficient to conclude that screening CT colonography improves net health benefits for asymptomatic, average risk Medicare beneficiaries. While it is a promising technology, many questions on the use of CT colonography need to be answered with well-designed clinical studies that focus on health outcomes for the Medicare population," the agency wrote.

CTC for colorectal cancer screening remains not covered, according to CMS; however, the agency is seeking public comments on the proposed determination.

"As with all national coverage analyses, the public may submit comments or additional evidence that cause us to reassess our evidentiary review and arrive at different conclusions," CMS stated. "If that should occur during finalization of this decision memorandum and we determine that CT colonography is clinically effective, then we would need to determine, using current or additional cost information, if CT colonography is cost effective. We are asking for public comment on the cost effectiveness of screening CT colonography for the Medicare population if we were to alter our clinical decision."

In May 2008, following the completion and publication of several large studies on screening CTC and updated CRC screening guidelines, CMS initiated a national coverage analysis to evaluate the evidence on CTC and to determine if it is sufficient for Medicare coverage. The analysis did not address the use of CTC as a diagnostic test. 

In November 2008, a Medicare evidence development and coverage advisory committee (MedCAC) meeting was held "to discuss the various kinds of evidence that are useful to support requests for Medicare coverage in this field." 

Until the evidence is sufficient, CMS said it "strongly encourages physicians and beneficiaries to participate in CRC screening by selecting one of the several CRC screening tests that are currently covered under Medicare."