More work needed for CT colonography reimbursement

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 - Medical Money

Continued scientific publications, legislative efforts, and public education about the value of CT colonography (CTC) are vital for achieving acceptance and reimbursement of the screening technique nationally, according to an article published in the December issue of the Journal of the American College of Radiology.

In 2008, CTC was endorsed as an acceptable method to screen the colon for polyps and masses by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the ACR. Many believed that full endorsement by Medicare and other insurance companies would follow shortly thereafter. However, “five years later, there are persistent challenges to full national acceptance and reimbursement for screening CTC,” said the article’s authors Abraham H. Dachman, MD, of the University of Chicago Medical Center, and Judy Yee, MD, of the University of California, San Francisco.

Dachman and Lee assessed the legislative activity that has already occurred in regards to support for CTC in colorectal cancer screening, and determined the path needed to achieve full reimbursement for the modality. CTC legislation has been submitted to the House of Representatives and the Senate since 2010, yet no action has been taken on any of the bills.

Congressional members continue to support CTC screening despite previous challenges, and the CT Colonography Screening for Colorectal Cancer Act of 2013 has been gaining national support with backing from ACR and patient advocacy groups.

Many insurance carriers currently reimburse for diagnostic or screening CTC, yet Medicare does not have a national coverage policy for the screening. Services may be covered by Medicare contractors on a local coverage basis, but these local carriers cannot cover screening for patients without symptoms because of regulations by the Centers for Medicare and Medicaid Services (CMS).

“The key to CMS’s agreeing to reimbursement is the upgrade of the USPFTF statues of screening CTC to grade A or B; ongoing legislative efforts are also important,” wrote Dachman and Lee. “Although peer-reviewed data already published support and justify full reimbursement for screening CTC, our continued efforts should concentrate on the publication of data to support the scientific arguments for CTC and on public opinion and legislation,” concluded the authors.