CT Colonography Fails NCA Test

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  • February 23, 2009
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The Centers for Medicare & Medicaid Services (CMS) proposes to make computed tomography (CT) colonography’s noncovered status a national coverage determination (NCD).

Thus far, CMS says, there is insufficient evidence to determine CT colonography is a valuable screening test for colorectal cancer (CRC) that improves health outcomes for average-risk Medicare individuals compared to optical colonoscopy.
The CT colonography (or virtual colonoscopy) uses X-ray images and computer software to create colon images. The procedure involves a full bowel prep, stool and fluid tagging with oral contrast, and room air or carbon dioxide insufflation of the colon. A CT scan is then performed in both the supine and prone positions while the patient is fully conscious. Colon and rectum images are produced to assess the presence or absence of structural lesions such as polyps and cancer. Since CT colonoscopy does not have a direct mechanism for removal of polyps, patients found with clinically important polyps must be referred for optical colonoscopy.
CRC screening tests procedures have been covered under Medicare Part B since 1998. Currently, Medicare covers:

  1. Annual fecal occult blood tests (FOBTs);
  2. Flexible sigmoidoscopy every four years;
  3. Screening colonoscopy for persons at average risk for CRC every 10 years or for persons at high risk for CRC every two years;
  4. Barium enemas every four years as an alternative to flexible sigmoidoscopy or colonoscopy; and
  5. Other procedures deemed appropriate by the Secretary of Health and Human Services (HHS).

CT colonography is currently reported with Category III codes 0066T Computed tomographic (CT) colonography (ie, virtual colonoscopy); screening and 0067T Computed tomographic (CT) colonography (ie, virtual colonoscopy); diagnostic. CPT® 2009 instructs coders not to report diagnostic radiology codes 72192-72194 and 74150-74170 in conjunction with 0066T or 0067T.
CMS first issued a national coverage analysis (NCA) for CT colonography May 19, 2008.
Further details are given in the Feb. 11 proposed decision memo. To comment on CT colonography’s clinical and cost effectiveness before CMS makes a final determination, click on the orange button at the top of the decision memo.


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