Medicare patients can now benefit from expanded coverage of colorectal cancer screening tests, following advocacy by the Texas Medical Association and others in organized medicine.
As of Jan. 1, the Centers for Medicare & Medicaid Services (CMS) will gradually reduce coinsurance payments for Medicare patients who undergo unplanned colorectal screening tests until 2030, when the federal agency will waive such copayments altogether.
Currently, Medicare patients don’t pay for planned colorectal screening tests. However, any procedures stemming from such tests – such as diagnostic colonoscopies or flexible sigmoidoscopies – incur a 20% copayment.
Between 2023 and 2026, Medicare patients will pay 15% of the cost for any additional screening, according to CMS. Between 2027 and 2029, their share will drop to 10%.
TMA endorsed this policy change in a Sept. 6 letter to CMS regarding its proposed 2023 Medicare physician fee schedule.
“TMA continues to support the elimination of coinsurance for [these procedures] as this is sound policy that will reduce the financial burden facing Medicare [patients] whose screenings result in a diagnostic procedure,” the association wrote. “Elimination of coinsurance also will promote utilization of colorectal cancer screenings that save lives.”
Also as of Jan. 1, CMS reduced the minimum age for colorectal cancer screening from 50 to 45, heeding recommendations from the U.S. Preventive Services Task Force and following up on previous expansions to Medicare coverage for certain colorectal cancer screening tests in 2022. In addition, CMS expanded the regulatory definition of colorectal cancer screening tests in 2023 to include a follow-up screening colonoscopy after a Medicare-covered, non-invasive, stool-based colorectal cancer screening test returns a positive result.
TMA policy supports legislation requiring coverage for colorectal cancer screening that follows the most recently established national guidelines.
Colorectal cancers are projected to be the second-leading cause of cancer deaths in Texas this year, with 4,447 expected deaths, according to the Texas Cancer Registry.
Last Updated On
February 24, 2023
Originally Published On
December 02, 2022