Despite strong data, CMS drops coverage for virtual colonoscopy

May 14, 2009
Ronald Piana
Ronald Piana

In a decision that many in the oncology community view as penny-wise, dollar-foolish, CMS reversed its decision to cover CT colonograhpy as a screening tool in colorectal cancer. Proponents of CT colonography contend that the less invasive nature promotes adherence to regular screening; critics say CT colonography's inability to remove polyps creates unnecessary redundancy; if polys are detcted the gold standard optical method is then needed. Why not just do it the first time?

CMS announced a final decision that it will no longer cover CT colonographies (CTC) despite evidence from several large, well-regarded studies that showed CTC was a valuable colorectal cancer screening tool. However, CMS stated that "the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries."

The decision provoked a mixed response from advocates and critics of "this promising technology." It also dealt a body blow to medical imaging companies that produce the technology, such as General Electric Co., and Siemens AG.

In March of this year, more than 40 lawmakers from Capitol Hill signed a letter petitioning CMS to amend its decision. The lawmakers' collective weight, plus studies published in esteemed journals such as the New England Journal of Medicine, could not sway CMS.

One questions the rationale for a decision that, in effect, discourages screening. Although the much-dreaded pretest bowel-cleansing procedure is still needed, CT colonography is a less expensive and less invasive procedure than standard optical colonoscopy. And advocates of the CMS decision were quick to question the decision.

Speaking to this page, noted CTC expert, Abe Dachman, MD, FACR, said, "CTC experts strongly believe that current data support use of screening CTS in the Medicare-aged population as do a bipartisan group of Congress. Use of CTC screening makes sense and is consistent with President Obama's push for prevention and use of new technologies to benefit patients. Radiologists should work to publish data focused on the Medicare population."