Groups push for effort to have Medicare cover CT colongraphy

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Consumer and professional groups are asking Congress to pass a bill that would allow Medicare to cover virtual colonoscopies.

The bipartisan bill, introduced in the Senate this week as S. 3465, would expand Medicare coverage to include screening computed tomography colonography. Among the professional groups supporting the bill is the American College of Radiology.

S. 3465 was introduced by Senators James M. Inhofe (R-Okla.) and Bernie Sanders (I-Vt.). The companion bill (HR 1298) was introduced in the House by Reps. Brad Wenstrup (R-Ohio) and Danny Davis (D-Ill.). The House bill currently has more than 80 bipartisan cosponsors.

The non-invasive test, using CT, can identify suspicious polyps in the colon and is a less invasive alternative to traditional colonoscopies, which require patients to fast for 24 hours, clear their bowels and be anesthetized during the procedure.

Perceptions of the hardship of those tests cause a third of those 45 and older who should be screened for colorectal cancer to choose not to be tested. In addition, wide disparities between racial and ethnic groups exist, say the organizations supporting the bill. CT colonography can make a difference because its use significantly raises screening rates and lowers costs, they say.

Medicare is an outlier in not covering the procedure. Some 37 states now require insurance policies to cover virtual colonoscopies, and insurers that take part in federal exchanges are required by the Affordable Care Act to cover the exam with no copayment requirement for patients.

In addition, some health insurers—specifically, Cigna, Aetna, UnitedHealthcare, Anthem Blue Cross Blue Shield among others—cover the test. But Medicare does not cover beneficiaries who want the exam.

"CT colonography is as accurate as standard colonoscopy in most people, including those 65 and older, and is far less invasive,” says Judy Yee, MD, chair of the American College of Radiology colon cancer committee. “Medicare needs to cover CT colonography and help physicians save more lives."

"Medicare-covered access to CT colonography can attract many who would otherwise not be tested, allowing doctors to remove polyps before they become cancers and helping people prevent this deadly disease," adds Carolyn Aldigé, CEO and founder of the Prevent Cancer Foundation.

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