American College of Radiology, Patient Advocacy Groups Urge Feds to Fix CTC Coverage Gap

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04/07/2022

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The American College of Radiology and five patient advocacy groups are urging the federal government to fix a longstanding lack of coverage for colon cancer screening via CT.

ACR and others including the Colorectal Cancer Alliance have submitted a formal national coverage determination request, asking the Centers for Medicare & Medicaid Services to address this issue. CTC is the only primary cancer screening test endorsed by the U.S. Preventative Services Task Force and American Cancer Society but not covered by Medicare or traditional Medicaid, they wrote Tuesday.

Colorectal cancer disproportionately impacts communities of color, and those involved believe “virtual colonoscopy” could help address hurdles attached to the traditional testing method.

“The need for a driver or car transportation, the need to take a day off from work, and the need for anesthesia or sedation for someone with a fear based in cultural background are all important barriers to screening that may be faced by someone outside of the majority,” ACR and others wrote to Joseph Chin, MD, deputy director of CMS’ Coverage and Analysis Group, on April 5. “The opportunity for prevention through a direct visualization test should not be off the table of options. Lack of Medicare and Medicaid coverage for CTC is a contributor to inequities in healthcare for colorectal cancer screening.”

Cancer care advocates are asking the agency to reconsider a 2009 determination, declining to cover screening via computed tomography colonography. They note that new information has emerged since then, including updated USPSTF guidance (lowering the recommended screening age), President Biden’s relaunched call to quash cancer, and evidence that colorectal cancer hits minority populations harder.

Others signing the request to Chin included the Colon Cancer Coalition, the Prevent Cancer Foundation, the Blue Hat Foundation and the Black Women’s Health Imperative. ACR also sent a second letter to Health and Human Services Secretary Xavier Becerra asking him to exercise his authority to deem CTC as a covered screening service in the Medicare program.

“Medicare coverage for CTC has been a top priority for the ACR throughout the last decade, as the college strives for the mutual goal of screening as many patients as possible,” the organization said in a Wednesday news update. “Making another screening option available to Medicare beneficiaries will save lives.”

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