CMS Urged to Cover Virtual Colonoscopy for Medicare Beneficiaries


By covering a less invasive procedure, Medicare could save $1.7 billion per screening cycle.

The US Centers for Medicaid and Medicare Services (CMS) has recently been scrutinized for not offering coverage of virtual colonoscopy (CT cololonography) for Medicare beneficiaries.

Colorectal cancer patient advocacy groups, along with the American College of Radiology, and other medical associations call on the CMS to cover the procedure. The virtual colonoscopy has been assigned the highest rating from the United States Preventive Services Task Force for colorectal cancer screening, according to the Prevent Cancer Foundation.

This rating requires that insurers selling Affordable Care Act plans cover the service without cost-sharing. The groups believe that Medicare beneficiaries should receive coverage for the potentially life-saving procedure.

“The best colorectal cancer screening exam is the 1 that a person chooses to use. Too many Americans are dying from a largely preventable disease that can almost always be treated if found early,” said Eric Hargis, public policy adviser for the Colon Cancer Alliance. “Medicare coverage of virtual colonoscopy would ensure access to a proven screening method for those who cannot, or will not, have an optical colonoscopy. This will save lives.”

The virtual colonoscopy is also beneficial for these patients, since it is less invasive than optical colonoscopy and does not require sedation. It is also just as accurate as the optical colonoscopy.

“To increase screening rates among seniors, Medicare must cover innovative, lifesaving virtual colonoscopy. Seniors need more fully covered screening options that they are likely to use,” said Anne Carlson, executive director of the Colon Cancer Coalition. “Medicare coverage for virtual colonoscopy would be a major step forward in the battle against colorectal cancer.”

Large insurers such as Cigna, UnitedHealthcare, Anthem Blue Cross Blue Shield, and others already cover the test, according to the article. A recent study published by Abdominal Imaging discovered that virtual colonoscopy among Medicare patients would save up to $1.7 billion per screening cycle.

Covering this type of colonoscopy would increase screenings and decrease colorectal cancer-related deaths.

“Medicare coverage of CT colonography would remove a financial barrier to this screening option that can overcome cultural stigmas and attract more people to be screened,” said Judy Yee, MD, chair of the American College of Radiology Colon Cancer Committee. “This would prevent many cancers, find more cancers before they progress and save thousands of lives each year from this terrible, but often preventable, disease.”

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