Thursday, July 7, 2022

NCD Watch: CMS Declines Request to Expand Colorectal Screening Benefits

Medicare has a statutory benefit for conventional stool screening and colonoscopy, but the same section of law allows Medicare to expand to other technologies through the NCD process.   Using this process, CMS has progressively added fecal immuno testing (FIT), ColoGuard, and a benefit for blood-based screening tests if 74% sensitive and 90% specific.  (No such test has been FDA approved, but qualified tests from Guardant and others are expected before long).

One gap is the use of CT colonography (once called "virtual colonoscopy," which now sounds like a colonic Zoom call).   A decade ago, CMS reviewed CTC and nixed it as a benefit.

On April 5, 2022, American College of Radiology (ACR) formally requested that CMS reconsider the status of CTC.   Now, ACR issues a press release that CMS declined the request.

Because CTC is endorsed by the USPSTF for CRC screening, it must be covered by private insurance (see June 29 posting below).   However, Medicare only needs to cover benefits that are electively taken up for an NCD review, and pass it.

  • Read the initial April 6 press from ACR about its proposal - here.
  • See the 15 page April 5 ACR letter to CMS, PDF in the cloud here.
    • ACR checked the right boxes - it's co-branded with support groups like Colorectal Cancer Alliance and Black Women's Health Imperative.
    • Colorectal cancer deaths are 40% higher for Blacks, in part due to lower uptake of fecal-based screening methods (here).
  • See the June 29 turn-down from CMS, in an ACR press release here.