In relatively unknown provisions of the 2025 final Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) rulemaking, the Centers for Medicaid and Medicaid Services (CMS) has approved payments for a colorectal cancer test that has the prospect of vastly increasing the early diagnosis of such cancers. Heretofore, the most used screening test for colon cancer has been colonoscopy, performed on patients who are under general anesthesia or conscious sedation. An additional non-invasive test is now available, with the likely result of a significantly increased numbers of colon cancer screening studies performed for asymptomatic Medicare patients. As of January 1, Medicare will now cover CT colonography (CTC) for these patients.

The need for general anesthesia or conscious sedation necessary for colonoscopy has served as a barrier that has complicated the preparation and the costs for those studies. In addition to the cost of the anesthesia care, many patients of Medicare age must visit their primary care physician's office where they are required to undergo electrocardiography (EKG) studies to assure they can safely receive the anesthesiology services that are ancillary to colonoscopy studies performed in outpatient hospital or ambulatory surgery center locations.

In addition to the elimination of the need for an EKG for many patients, stakeholders who have long advocated for payment for CTC note that the CT study is safer. CT colonography has a lower risk of perforation than colonoscopy. It is also less invasive: CT colonography is minimally invasive and doesn't require a scope to be inserted into the rectum; and procedure time is shorter: the non-contrast CT scan only takes seconds after the patient is positioned.

Added benefits are the value of incidental findings since CTC with findings outside of the colon can detect such findings as an abdominal aortic aneurysm and osteoporosis. Also, CT colonography can help distinguish between acute and chronic inflammatory bowel disease. 

While patients who have a colonoscopy take comfort that colonoscopy allows real time biopsies of pre-cancerous polyps before they become cancerous, patients, like myself, who have had a series of colonoscopy procedures done without the need for biopsies, may be willing to choose the more efficient and less costly route by choosing CT colonography over the more expensive and more time-consuming colonoscopy. 

The American College of Radiology has applauded the new Medicare coverage for CTC, particularly for the expected improvement in access for colorectal cancer screening tests brought about by the availability of this study.  Judy Yee, MD, FACR, Chair of the ACR Colon Cancer Committee describe its positive benefits very well: “This decision will help improve access to CRC screening for underserved populations and people of color to help improve health disparities. Our goal is to continue to improve CRC screening rates across the country. Similar to colonoscopy, CTC can help prevent cancer by detecting the precursor polyp before it becomes cancerous.”

I believe that there will be widespread patient acceptance of this less invasive, less costly and less time consuming method to screen for the early detection of colon cancer.