Bill introduced to add VC to Medicare screening coverage

Dec 19, 2007

A bill introduced yesterday in the U.S. House of Representatives would add virtual colonoscopy (VC or CT colonography [CTC]) to the list of colorectal cancer screening alternatives covered by Medicare.

H.R. 4879, the Virtual Screening for Cancer Act (VSCA) of 2007, is sponsored by Representative Barbara Cubin (R-WY), and co-sponsored by Representative Edolphus Towns (D-NY). Cubin is looking for sponsors for the legislation.

"She is absolutely putting the call out for more co-sponsors," Cubin's press secretary Kristin Walker told AuntMinnie.com by telephone.

A statement released today on Cubin's Web site offered support for VC's ability to screen for colorectal cancer less invasively than conventional colonoscopy.

"Colorectal cancer is the third leading cause of cancer death in the United States today," Cubin said. "Early detection is the most effective method we have to combat this killer. Unfortunately, too many Americans shy away from traditional colonoscopy exams because of the discomfort associated with it. Virtual colonoscopies provide a more comfortable screening alternative that will lead to more patients getting the treatment they need."

In addition to expanding Medicare coverage to include VC, the bill would make the exam part of the Welcome to Medicare program. This means Medicare beneficiaries would have their co-pays for virtual colonoscopies waived when the exam is conducted within the first six months of the beneficiaries' enrollment in Medicare, as is currently the case for conventional colonoscopies and mammograms.

Cubin, a member of the House Committee on Energy and Commerce's health subcommittee, worked with the medical community to craft the legislation. Yesterday the bill was referred to the Committee on Energy and Commerce, and the Committee on Ways and Means.

Overview of the legislation

Beginning in January 2009, VC would be reimbursed for individuals 50 years and older in ambulatory surgical centers or hospital outpatient departments, under the physician fee schedule and consistent with "similar or related services."

H.R. 4879 bases payment for screening VC on diagnostic VC, which is already billable under several local coverage determinations under Medicare. A diagnostic CTC can be ordered in some Medicare areas when symptoms or signs of disease are determined by a physician to be present, as opposed to a screening CTC test that would be available under the bill regardless of signs or symptoms.

The bill provides for coverage of CTC in ambulatory surgical centers (ASC) at the lesser of the ASC rate or the Hospital Outpatient Department (HOPD) rate. It ensures that the ASC/HOPD coinsurance for screening VC does not exceed 25% of what Medicare pays under the relevant fee schedule. (Twenty-five percent is the current coinsurance rate for flexible sigmoidoscopy and colonoscopy.)

Frequency limitations would apply. For individuals at high risk of colorectal cancer, CTC will be available every 23 months, or 23 months following screening colonoscopy. For individuals not at high risk, CTC will be available 47 months after a previous CTC exam, 47 months after the patient's last flexible sigmoidoscopy exam, or 119 months following a conventional screening colonoscopy, the bill's text states.

Finally, the bill would exempt screening VC from the cuts to imaging services reimbursement under Medicare imposed by the Deficit Reduction Act of 2005.

"Representative Cubin is retiring at the end of this Congress (December 2008), so this is legislation she'd really like to see pass through before she leaves Washington," Walker said.

By Eric Barnes
AuntMinnie.com staff writer
December 20, 2007

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Midwest weighs incremental Medicare gain for VC, May 26, 2005