Do payors currently reimburse for CTC?
Because of some of the early variability in CTC studies, CTC is still considered “investigational” by the AMA, CMS, and the major cancer screening guidelines. Further, CTC is not currently considered an acceptable CRC screening modality by the NCQA’s HEDIS measurement system. Ironically, tests that are clearly inferior to CTC, such as FOBT, Flex Sig, and DCBE are currently “acceptable” and reimbursed modalities of CRC screening. These tests have a significantly lower sensitivity and specificity for CRC screening compared with CTC. A small number of commercial payors do currently reimburse for CTC in the state of Wisconsin. The AMA will be reviewing the possibility of creating a full CPT code for CTC. Commercial payors and Medicare will likely see the benefits of CTC with respect to cost and patient acceptability and will begin to reimburse for it as a screening test.
