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| Section: | Radiology |
| Number: | X-52 |
| Topic: | CT Colonography/Virtual Colonoscopy |
| Effective Date: | October 16, 2006 |
| Issued Date: | October 16, 2006 |
| Date Last Reviewed: | 10/2006 |
Indications and Limitations of Coverage
CT Colonography, also known as virtual colonoscopy, is considered eligible when medically indicated for patients who cannot tolerate an endoscopic colonoscopy. Examples of these conditions include:
CT colonography for all other clinical indications is considered not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service. CT colonography is not covered when performed as a screening procedure to evaluate asymptomatic patients (patients without signs and/or symptoms of disease or illness). In this case, a participating, preferred, or network provider can bill the member for the denied service. Description CT colonography is often referred to as "virtual colonoscopy." This diagnostic imaging technique for visualizing the colon can be used as an alternative to conventional endoscopic colonoscopy for certain conditions. It involves insufflation of the colon to perform a special computed tomographic (CT) study called a helical or spiral CT scan. CT colonography takes many high-resolution, thin pictures of the structures in the abdomen. A computer then uses the acquired image data to reconstruct 2- and 3-dimensional images of the inside of the colon. The resulting images resemble the endoluminal images obtained with conventional endoscopic colonoscopy. This helps the provider detect any abnormalities that may require a closer look. Similar to conventional colonoscopy, CT colonography requires the full bowel preparation or cleansing regimen prior to the study. However, CT colonography generally requires no sedation, is less invasive, and less time consuming. It does not carry the small but real risk of bowel perforation associated with conventional colonoscopy.It can detect larger polyps, but may not be as sensitive at detecting smaller lesions. |
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Under the Federal Employee Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient’s condition. CT colonography/virtual colonoscopy is considered eligible when determined medically necessary based on the patient’s condition. |
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National Blue Cross Blue Shield Technology Assessment, March 2005 American College of Radiology Practice Guidelines for the Performance of Computed Tomography (CT) Colonography in Adults, October 2005 Guidelines: Technology Status Evaluation Report, Gastrointestinal Endoscopy, April 2003 CT Colonography for Colon Cancer Screening, Gastrointestinal Endoscopy, January 2006 Multislice CT Colonography: Current Status and Limitations, Radiologic Clinics of North America, November 2005 The Emerging Role of Virtual Colonoscopy, The Medical Clinics of North America, January 2005 CT Colonography: Unraveling the Twists and Turns, Current Opinion in Gastroenterology, January 2005 Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults, The New England Journal of Medicine, December 2003 The Future of Colorectal Cancer Screening, American Cancer Society New Today, February 2003 Screening for Colorectal Cancer in Adults at Average Risk: A Summary of the Evidence for the U. S. Preventive Services Task Force, Annals of Internal Medicine, July 2002 Cost-effectiveness Analyses of Colorectal Cancer Screening: A Systematic Review for the U. S. Preventive Services Task Force, Annals of Internal Medicine, July 2002 National Blue Cross Blue Shield Medical Policy Reference Manual, 6.01.32, October, 2003 |
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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.
Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.
Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
