VC gets BCBSA TEC endorsement, Maryland coverage

Nov 30, 2008

Momentum is growing for increased insurance coverage of virtual colonoscopy, also known as CT colonography (CTC), as a colon cancer screening modality.

Last week, the Blue Cross/Blue Shield Association Technology Evaluation Center (BCBSA TEC) gave its final approval for VC as a screening modality. In other coverage news, Maryland has also recently mandated that VC be included as a covered screening modality in all of the state's insurance plans, though small employers are currently exempted from the requirement.

Blue Cross/Blue Shield Association TEC

The BCBSA TEC assessment, currently in press, states that there is adequate evidence showing that VC is effective in reducing mortality from colon cancer. While TEC's approval does not constitute a mandate for coverage under BCBS healthcare plans, it is considered an important endorsement of VC technology that can be expected to result in many coverage policy changes in the near term.

TEC creates approximately 25 evidence-based assessments of medical technologies per year. Virtual colonoscopy's assessment, initiated in 2007, had been on hold pending final publication of the National CT Colonography Trial (ACRIN 6664) results and the November 19 MedCAC meeting held in Baltimore.

The TEC assessment is based largely on results of the recently published National CT Colonography Trial, and on the March 2008 inclusion of virtual colonoscopy in the American Cancer Society's (ACS) screening guidelines. The revised TEC assessment states that VC is an effective screening exam for colorectal cancer and that it has met the organization's standard five criteria for endorsement:

The technology must have final approval from the appropriate governmental regulatory bodies.
The scientific evidence allows conclusions concerning the effect of the technology on health outcomes.
The technology must improve the net health outcome.
The technology must be as beneficial as any established alternatives.
The improvement must be attainable outside the investigational settings.

The draft BCBSA TEC assessment can be found on the BCBS Web site.

Maryland mandates VC coverage

The state of Maryland's Department of Insurance recently issued a directive (Bulletin 08-33) for coverage of VC for all Maryland-based health insurers. Small employers are exempted from the requirement. Effective September 15, 2008, the directive amends insurance article 15-837, Annotated Code of Maryland, to require insurance carrieres to cover VC as well as the stool DNA test, in accordance with the revised American Cancer Society guidelines.

CMS announces VC evidence meeting, September 26, 2008

ACR, others exhort CMS to cover virtual colonoscopy, June 19, 2008

CMS launches comment period for VC coverage, May 20, 2008

American Cancer Society recognizes virtual colonoscopy screening benefit, March 5, 2008