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Medical News & Perspectives | April 1, 2009

Virtual Colonoscopy Dealt Setback With Rejection for Coverage by Medicare

Mike Mitka

JAMA. 2009;301(13):1327-1328. doi:10.1001/jama.2009.404.

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Many in the US cancer prevention community thought the recent accumulation of data showing the effectiveness of computed tomography (CT) colonography, or virtual colonoscopy, as a screening tool for colorectal cancer would be enough to ensure that the procedure would be covered under Medicare. But they were wrong.

On February 11, the Centers for Medicare & Medicaid Services (CMS) issued a “proposed decision memo” saying that because there is not adequate evidence indicating that CT colonography is an appropriate colorectal cancer screening test, the agency would not offer coverage for the procedure (https://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?from2=viewdraftdecisionmemo.asp&id=220&). The memo came following a November meeting of a Medicare Evidence Development & Coverage Advisory Committee. And while the CMS could reverse its decision, newsaccounts suggest that would be highly unlikely.

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While computed tomography colonography can identify large polyps, it will not be covered under Medicare, partly because of questions about its efficacy in an older population.

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Mitka M. Virtual Colonoscopy Dealt Setback With Rejection for Coverage by Medicare. JAMA. 2009;301(13):1327-1328. doi:10.1001/jama.2009.404.

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