Virtual Colonography Not Visualized by CMS

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The Centers for Medicare and Medicaid Services (CMS) has decided as of yesterday not to cover CT colonography for colorectal cancer screening.

CMS began looking at its policy regarding virtual or CT colonography in May 2008. Over the past year they have looked at the submitted comments, clinical studies and other scientific information related to the technology.

CMS issued its final decision memo yesterday that reiterates the coverage denial stating, "The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under § 1861(pp)(1) of the Social Security Act."

While the American Gastroenterology Association (AGA) is pleased with the decision, the American Cancer Society (ACS) is not. AGA points out the limitations of CT colonography which include increased radiation exposure to patients, potential failure to spot small or flat lesions, and the need for positive findings (polyps, etc) to be confirmed and polypectomy done with an optical colonoscopy.

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The American Cancer Society feels that the randomized trials have clearly shown CT colonography to be an effective cancer screening and feel more older Americans would be screened with the virtual colonography than are being screened now.

Moreover, positive findings with the virtual procedure must be confirmed -- and polypectomy performed -- with an optical colonoscopy. As a result, costs of CT colonography scans with positive findings are markedly higher than screenings conducted with ordinary colonoscopy.

CMS also noted that many studies of CT colonography included only small numbers of Medicare-age patients or excluded them altogether. With the costs of health care in this group increasing so rapidly, the potential increased costs of “two” tests (the virtual and then the optical) are a real concern.

Related source:

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Final CMS decision memo

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