Patient and Provider Groups Call on Congress to Pass Medicare Virtual Colonoscopy Coverage

Nov 11, 2015, 12:48 ET from American College of Radiology

WASHINGTON, Nov. 11, 2015 /PRNewswire-USNewswire/ -- Medicare coverage for virtual colonoscopy (known as CT colonography) can lower costs, increase colorectal cancer screening rates and save thousands more lives each year. A number of colorectal cancer care advocacy groups, representing millions of Americans, and the American College of Radiology (ACR) urge Congress to pass the CT Colonography Screening for Colorectal Cancer Act (S. 2262). The legislation would provide Medicare coverage for seniors who choose these screening exams and remove a financial barrier to care widely covered by private insurance.

"A third of those who should be screened for colorectal cancer can't have or won't get a colonoscopy. CT colonography increases screening rates where offered. Medicare coverage would provide seniors with insured access to an exam that may appeal to them. This would jump-start screening, catch more cancers early and saves more lives," said Eric Hargis, Chief Executive Officer, Colon Cancer Alliance.

CT colonography (CTC) has long been an American Cancer Society-recommended screening test. A recent major study shows that screening Medicare patients with CT colonography would cost 29 percent less than with optical colonoscopy and save up to $1.7 billion per screening cycle. CIGNA, UnitedHealthcare, Anthem Blue Cross Blue Shield and other major insurers cover screening virtual colonoscopy. More than 20 states require insurers to cover these exams. Yet, Medicare does not cover beneficiaries for CT colonography.

"Medicare coverage for virtual colonoscopy would provide access to a proven test that more seniors may use. This is vital. Colorectal cancer is one of the few cancers that we can often prevent. Detecting precancerous polyps can stop them from becoming cancer. This saves lives," said Carolyn R. ("Bo") Aldigé, President and founder of the Prevent Cancer Foundation.

Anne Carlson, Executive Director of the Colon Cancer Coalition echoes this, "In order to increase screening rates amongst seniors, Medicare must cover virtual colonoscopy. Not only will coverage of these exams increase screening rates, but it would save money and lives."

Virtual colonoscopy has been proven comparably accurate to colonoscopy in most people — including those ages 65 and older. Virtual colonoscopy is less invasive than optical colonoscopy and does not require sedation. Patients can go back to daily activities. President Obama chose a virtual colonoscopy in his first checkup as Commander-in-Chief.

"We need to innovate to increase colorectal cancer screening rates. Medicare virtual colonoscopy coverage provides an option that more seniors may choose. Early detection through increased screening saves lives, enables less extensive treatment and preserves quality of life. We call on Congress to provide this coverage," said Michael Sapienza, President and founder, Chris4Life Colon Cancer Foundation.

In recent draft recommendations, the U.S. Preventive Services Task Force (USPSTF) named virtual colonoscopy an "alternative" screening exam. It is unclear how this may affect coverage and resulting patient access, since the USPSTF did not grade specific screening exams. The American Cancer Society strongly supported CT colonography in its comments to the Task Force on those draft recommendations. The ACR has urged the Task Force to reclassify CT colonography as a "recommended screening exam." Under the Affordable Care Act, private insurers are only required to cover (with no copay) exams given an "A" or "B" grade. Medicare determines coverage separately.

"At present, seniors who want a CT colonography have to pay for the exam out of pocket — on top of the annual Medicare premium. Many, who might not get tested otherwise, can't overcome this financial barrier. Congress can provide seniors with the same screening options as the privately insured by passing S. 2262," said Anjee Davis, President of Fight Colorectal Cancer.

"Colorectal cancer is almost always treatable if found early by screening and the cost to screen and prevent the disease is exponentially less than to treat cancers not found until advanced stage. Passage of S. 2262 can help save lives and reduce screening exam costs," said Judy Yee, MD, Chair of the American College of Radiology Colon Cancer Committee.

S. 2262 is cosponsored in the U.S. Senate by Sen. James Inhofe (R-OK) and Sen. Bill Nelson (D-FL). 

Find more virtual colonoscopy information at Providers CTC resources are at



SOURCE American College of Radiology