Government
Medicare won't cover virtual colonoscopies
■ Radiologists say the less-invasive procedure would get more people in for testing and are calling on Congress to reverse the final CMS decision.
By Chris Silva — Posted May 27, 2009
Washington -- The Centers for Medicare & Medicaid Services issued a final decision May 12 stating Medicare will not cover virtual colonoscopies, also known as CT colonography.
CMS stated that "the evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test." The national decision means Medicare will continue to cover conventional colonoscopies but will not pay for the relatively new treatment option.
The decision is a setback to medical experts who consider the procedure an effective alternative to conventional colonoscopies. The American College of Radiology said if CMS does not reverse its determination and provide coverage, then Congress should pass legislation requiring Medicare to cover the exam.
Virtual colonoscopies use x-ray technology to create three-dimensional, fly-through images of the colorectal structure, ACR said. The process does not require sedation, and the less-invasive treatment would convince more people to receive needed testing, the organization argued.
"For CMS to turn its back to a technology that can attract more patients to be screened and save countless lives is deeply concerning," said James H. Thrall, MD, chair of ACR's board of chancellors.
After the publication of several major studies on the new exams, CMS in May 2008 initiated a national coverage analysis to evaluate the procedure's effectiveness and determine if sufficient evidence supported Medicare coverage. The agency determined that it was less effective than traditional colonoscopies at detecting polyps that were small, flat or depressed.
CMS did call virtual colonoscopies a "promising technology" in its final decision. However, "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 concluded.
The American Gastroenterological Assn. has said it will continue to monitor the issue and to train gastroenterologists in the new technology.
