The Centers for Medicare and Medicaid Services has denied the American College of Radiology’s request to reconsider their National Coverage Determination regarding coverage of computed tomography colonography exams as a means to screen for colorectal cancer.
In the June 29 announcement, the ACR revealed CMS said the additional evidence provided to them was “insufficient” to support the reconsideration of their non-coverage decision that was made in May of 2009.
The ACR refuted this claim, stating: “The ACR and the patient advocacy groups contend ample clinical evidence was provided to support coverage of this valuable preventive screening service.”
The evidence submitted by the ACR and other organizations included recommendations provided by the United States Preventive Services Task Force (USPSTF). In May 2021, the USPSTF included the use of computed tomography colonography (CTC) in their final colorectal cancer screening recommendations. That recommendation also suggested reducing the screening eligibility age to 45.
Despite this endorsement, CTC screening remains the only test recommended by the USPSTF and American Cancer Society (ACS) that is not covered by Medicare or traditional Medicaid as a primary cancer screening option. The Affordable Care Act requires that private insurers cover all USPSTF-recommended screenings without cost-sharing, so when patients who have been utilizing CTC screening become eligible for Medicare, they are at risk of losing access to the exam.
A meeting between the ACR and the CMS Coverage and Analysis Group to discuss the reasoning behind the denial is set to take place in July.
Read the full ACR statement here.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.