Study finds high utilization of CTC and Medicare coverage in recent years

Medicare coverage and nationwide utilization of computed tomographic colonography (CTC), commonly referred to as virtual colonoscopy, has tripled in recent years, according to a study in the April issue of the Journal of the American College of Radiology (www.jacr.org). CTC employs virtual reality technology to produce a three-dimensional visualization that permits a thorough and minimally invasive evaluation of the entire colon and rectum. CT colonography is an alternative to conventional optical colonoscopy for colorectal cancer screening and diagnosis.

Colorectal cancer is the second leading cause of cancer deaths in the U.S. Yet, only 50 percent of the eligible population participates in colorectal cancer screening programs. Since most colon cancers develop from polyps, and screening to find and remove these polyps can prevent colon cancer, an opportunity exists to save lives with early detection. CTC, which is an American Cancer Society recommended screening exam, can attract more people to be screened and save more lives through early detection of disease.

"Several well-designed multicenter trials now corroborate the results of an earlier landmark trial demonstrating equivalent performance of conventional optical colonoscopy and CTC in screening for cancer and precancerous polyps. The rapid expansion of the use of diagnostic CTC, even in the absence of Medicare coverage for screening CTC, speaks volumes to the need of an alternative exam for those who choose not to undergo colonoscopy. As more insurers provide coverage for CTC, access to CTC is likely to expand," said Richard Duszak Jr., MD, lead author of the study.

Medicare claims for diagnostic CTC were identified for the first four complete years for which Current Procedural Terminology- tracking codes existed. The frequencies of billed and denied services were extracted on a national and regional basis, along with physician provider specialty and site of service. Researchers found that between 2005 and 2008, annual claims for diagnostic CTC for Medicare fee-for-service beneficiaries increased by 195 percent (from 3,660 to 10,802). Most services were performed in office and outpatient hospital settings, with only a small number in the inpatient hospital and other miscellaneous settings.

"Given its recent technological and clinical maturation, the expansion of CTC across the country is not unexpected. Although regional variation exists, coverage for diagnostic CTC continues to expand across the country, setting the stage for expanded patient access. Medicare coverage of screening CTC could spark wider access to this potentially life-saving exam and help raise what have traditionally been low colorectal cancer screening rates," said Duszak.