CT Colonography: Navigating the Path to Reimbursement

May 9, 2013
Sara Michael

VIDEO: Reimbursement for CT colonography has been a complicated path, but radiologists shouldn’t wait to pursue local coverage and set up a screening program, said Perry Pickhardt, MD.

Reimbursement for CT colonography has been a long and at times piecemeal path.

Now, there are a few approaches to covering CTC, also known as virtual colonoscopy, said Perry Pickhardt, MD, chief of gastrointestinal imaging at the University of Wisconsin School of Medicine and Public Health. There’s the grassroots approach through local payers, a legislative approach through Congress or the broader, more immediate approach would be to have CMS cover it as a screening tool.

But CMS has declined to cover the procedure until the United States Preventative Services Task Force gives it a positive rating (and as of now, they’ve given it one of “insufficient evidence”).

But that doesn’t mean radiologists shouldn’t act on providing the procedure, Pickhardt said.

“I do think a lot of radiologists are our own worst enemy in some respects,” he said at an interview at the recent ARRS conference in Washington, DC. “There’s some inertia, people waiting on the sidelines for broader coverage before they jump in.”

But practices should be more proactive, he explained, by determining local coverage and working to set up a screening program. By getting a program set up now, practices can be ready to hit the ground running when coverage comes through.