CT Colonography Screening to Be Preventive Benefit for Medicare Advantage Members, Effective July 1, 2018

The United States Preventive Services Task Force (USPSTF) recognizes computed tomography (CT) colonography (virtual colonoscopy) as an acceptable screening option for detecting colorectal cancer.

At this time, the Centers for Medicare & Medicaid Services (CMS) does not mandate Medicare Advantage (MA) plans to cover CT colonography as a colorectal cancer screening test. However, Highmark has decided to fully cover CT colonography with no copay for its MA members under our Preventive Schedule beginning July 1, 2018, because of the test’s high efficacy rate and affordability.

Who Will Be Covered?

All MA members ages 50 to 75 who are at average risk of developing colorectal cancer will be covered. If providers believe CT colonography is the most appropriate colorectal cancer screening test, our members will be able to obtain this service without any out-of-pocket cost.

This may not be the most appropriate screening for everyone. Colonoscopy remains the gold standard for detecting colorectal cancer and should remain the screening of choice for those who are considered to be at high risk.

Diagnosis Requirements

CT colonography screening (CPT code 74263 — Computed tomographic [CT] colonography, screening, including image postprocessing) will be covered once every five years for eligible MA members when billed with any one of the following ICD-10-CM codes:

• Z12.10 – Encounter for screening of malignant neoplasm of intestinal tract, unspecified
• Z12.11 – Encounter for screening for malignant neoplasm of colon
• Z12.12 – Encounter for screening for malignant neoplasm of rectum
• Z80.0 – Family history of malignant neoplasm of digestive organs
• Z80.8 – Family history of malignant neoplasm of other organs or systems
• Z80.9 – Family history of malignant neoplasm, unspecified
• Z83.71 – Family history of colonic polyps