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March 27, 2018


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Medical Coding News Archives

CMS Analyzes Coverage of Screening Colonography

 
October 28, 2008:

If the Centers for Medicare and Medicaid Services decides to cover computed tomography colonography, other payers could follow suit. The agency is conducting a national coverage analysis and plans to release a proposed decision in February 2009.

Right now, the Centers for Medicare and Medicaid Services offers colorectal cancer screening through various modalities, including fecal occult blood testing, sigmoidoscopy, colonoscopy, and barium enema. Coverage for these service is extended to average-risk individuals, 50 years of age or older.

The American Cancer Society, as well as the US Multi Society Task Force on Colorectal Cancer and the American College of Radiology, issued new guidelines on March 5, 2008, regarding cancer screening. One recommendation advised considering whether CTC, or computed tomography colonography, as a viable option to other screening modalities for these particular individuals. Medicare (and most other payers) does not cover CTC under the existing colorectal cancer screening benefits.

CTC is also called a “virtual” colonoscopy. It uses CT to acquire images as well as 2- and 3-dimensional image display techniques for interpretation. At this time, there are two category II codes that may be used to report or track this service: 0066T Computed tomographic (CT) colonography (i.e., virtual colonoscopy); screening and 0067T Computed tomographic (CT) colonography (i.e., virtual colonoscopy); diagnostic.

On May 19, 2008, public comments were solicited to help CMS analyze national coverage. The agency is especially interested in data from clinical studies and other scientific information pertaining specifically to the CTC technology.

CMS, in concert with other appropriate organizations, is using the national coverage decision process to determine if other types of colorectal cancer screening tests, not currently approved, may be appropriate. This NCA will review all available evidence pertaining to screening CTC before determining whether a national coverage decision is warranted.

Karen M Prescott
Clinical/Technical Editor

 

 
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