Virtual Screening Tests for Colon Cancer Not Likely to be Covered by Medicare

February 25, 2009

Medicare might not cover non-invasive, CT-based colonoscopies that screen for colorectal cancer.

Medicare will not cover non-invasive, CT-based colonoscopies that screen for colorectal cancer, according to ongoing discussion.

A final decision will not be made until March 13, but the Centers for Medicare and Medicaid Services (CMS) are unlikely to change their position.

The organization cites decreased accuracy of CT scans for smaller lesions as the primary reason for denying coverage of the diagnostic test. Additionally, any positive results that are found with the virtual screening must be confirmed, which greatly increases costs.

One study the agency cited in its review of the screening tests noted that “the positive predictive value of CT colonography was only 25%,” even though the authors of the piece concluded that the test was accurate enough for screening purposes.

In a review of the Medicare population, CMS found that the majority of those patients had not been included in previous studies about CT-based colonoscopies, which primarily included patients younger than age 65 years. The group also cited “radiation-related risks and the complications introduced from extracolonic findings” in their rationale for not covering the screenings.

"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 CMS memo concluded.

Several professional medical societies have spoken out about Medicare’s impending decision. The American Gastroenterological Association (AGA) suggested that it be included as a benefit to most Medicare patients, though they did outline some restrictions. "The AGA agrees that the limitations of CT colonography cannot be ignored and must be taken under advisement in the development of a coverage policy for [the procedure]," the AGA statement read. "Concerns related to test sensitivity, specificity, reporting, training and technology requirements, radiation exposure, and appropriate surveillance intervals are well documented." However, they added that they “also support CT colonography and other screening tests if patients and their physicians believe that test is the appropriate one for them."

To see CMS statements on the subject, click here.

For more information about computerized screenings for colon cancer, click here.

specialty: oncology, gastroenterology