In a proposed coverage decision, the Centers for Medicare and Medicaid Services has announced that it will not pay for virtual colonoscopy after determining that "the evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test." CMS is taking public comments on the proposal for 30 days before making a final decision, but a former Medicare official tells the New York Times he expects the decision to stand.

CMS??? analysis recognizes several studies showing virtual colonoscopy to be an effective alternative to other, more invasive types of colon cancer screenings, but notes that "the mean age of participants in these studies??? was considerably younger than the Medicare aged population." For example, a study published in the New England Journal of Medicine last year examined the efficacy of virtual colonoscopy in patients with a mean age of 58; the mean age of Medicare beneficiaries (not including disabled beneficiaries) in 2007 was 75.5 years.

"While it is a promising technology, many questions on the use of CT colonography need to be answered with well designed clinical studies that focus on health outcomes for the Medicare population," concludes CMS in a memo. The American Society of Gastrointestinal Endoscopy applauds Medicare???s decision; the American Cancer Society opposes it.

—Irene Tsikitas