The American College of Radiology® (ACR®) is celebrating the decision by the Centers for Medicare and Medicaid Services (CMS) to finalize its proposal to allow coverage of CT colonography (CTC) for colorectal cancer (CRC) screening of Medicare patients beginning Jan. 1. CMS cemented coverage in its 2025 Hospital Outpatient Prospective Payment System (OPPS) and 2025 Medicare Physician Fee Schedule (PFS) final rules. This decision — long pushed by the College — provides Medicare patients with access to a minimally invasive CRC screening tool that can detect pre-cancerous polyps and does not require anesthesia.
While the coverage decision is a victory, ACR contends reimbursement is inadequate and patient access to this important tool may be limited. CMS linked screening CTC payment to the reimbursement cap mandated by the Deficit Reduction Act of 2005 (DRA), which requires that the technical component of imaging services to be paid at the lesser of the PFS ($591.29) or OPPS ($241.72) payment amount. ACR lobbied for CTC screening be exempt from the cap as mammography is exempted. CMS said, however, that it does not have the statutory authority to exempt CTC.
CMS did however agree in the OPPS final rule that this newly covered screening test for colorectal cancer should be assigned a payment rate that is more comparable to the purported resource costs and increased the reimbursement from $106.68 to $241.72. Therefore, the technical component reimbursement rate for screening CTC in 2025 will be $241.72 in both the hospital outpatient and physician office settings. The final professional component relative value unit (RVU) is 3.36 with a reimbursement rate of $108.68 using the current 2025 conversion factor of $32.3465.
For more information, contact Katie Keysor, ACR Senior Director of Economic Policy.