May 12, 2009 / 10:16 PM / 10 years ago

Medicare will not pay for "virtual" colonoscopy

WASHINGTON (Reuters) - Medicare, the U.S. federal health insurance plan for the elderly and disabled, will not pay for so-called virtual colonoscopies, which check for colon cancer using scans.

“Evidence is inadequate to conclude” that virtual colonoscopies, also known as CT colonography, are an appropriate colorectal cancer screening test for Medicare patients, the Centers for Medicare & Medicaid Services (CMS) said on Tuesday in a statement on its website.

The decision finalizes a February proposal from CMS.

Colonoscopies can detect colon cancer early, while it can still be treated or even cured, and usually involve using a camera threaded up through the rectum and into the colon. People find the procedure embarrassing and uncomfortable and some studies have shown using an external scan can be nearly as effective.

But a doctor doing a colonoscopy can also remove pre-cancerous lesions on the spot. If growths are seen using a scan, the patient must then undergo a colonoscopy anyway. Insurers rarely pay for “virtual” colonoscopies.

The American Cancer Society and other groups had argued in favor of Medicare coverage of the scans, saying they could motivate seniors to undergo a screening test they might otherwise avoid.

The CTC Working Group, a coalition of doctors, patients and imaging equipment manufacturers, urged Medicare to reconsider the ruling.

Virtual colonoscopy “can overcome patient objections to being screened, detect cancer early when it is most treatable, and ultimately save lives. If CMS will not reconsider this coverage decision, Congress should vote to mandate Medicare coverage” of the technology, Dr. James Thrall, chair of the American College of Radiology Board of Chancellors, said in a statement issued by the coalition.

New Hampshire-based iCAD Inc is one company providing computer-aided detection or CT colonography equipment.

An official at iCAD could not immediately be reached for comment.

Reporting by Lisa Richwine and Maggie Fox; Editing by Richard Chang and Carol Bishopric

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