RetiredCareFirstPolicy 6.01.028

Computed Tomographic Colonography as a Test for Colon Cancer (Virtual Colonoscopy)

This CareFirst policy addresses the use of computed tomographic colonography (CTC, virtual colonoscopy) as a test for colon cancer screening; it states the coverage position and references replacement operating procedure 2.03.011A. The policy is retired as of 2025-02-01 and is no longer scheduled for review.

Policy Summary

PayerCareFirst

PolicyComputed Tomographic Colonography as a Test for Colon Cancer (Virtual Colonoscopy)

Policy CodePolicy 6.01.028

Change TypeRetired / Replaced

Effective DateJun 13, 2001

Next Review Date

Key ActionThis retired policy has been replaced by Operating Procedure 2.03.011A; providers should follow that operating procedure for current coverage guidance.

POLICY UPDATE CHANGES

Policy retired and replaced by Operating Procedure 2.03.011A as of 2025-02-01.

Last revision recorded 2025-02-01 indicating retirement and replacement.

RetiredPolicy status

ExperimentalCoverage stance prior to retirement

2.03.011AReplacement policy

Coverage Summary

This policy addresses computed tomographic colonography (CTC, also known as virtual colonoscopy) as a test for colon cancer screening. The policy is retired as of 2025-02-01 and replaced by Operating Procedure 2.03.011A. The policy's effective date was 2001-06-13 and the last review recorded was 2007-08-17.

Medical Necessity / Coverage Determination

Coverage Determination

Policy statement

The use of computed tomographic colonography is considered experimental / investigational

Does not meet TEC criteria # 2-5

Not Covered / Experimental

Coverage stance prior to retirement: the use of computed tomographic colonography was considered experimental / investigational (does not meet TEC criteria #2-5). Evidence summary: the available evidence was inconsistent regarding CTC as a screening or diagnostic tool, there were no studies demonstrating that CT colonography reduces morbidity or mortality from colorectal cancer, and the USPSTF (2002) concluded that no studies had evaluated CT colonography for reducing morbidity or mortality.

Provider Actions

Documentation Required

Use replacement operating procedure

This policy has been retired and replaced by Operating Procedure 2.03.011A. Providers should follow Operating Procedure 2.03.011A, Screening for Colorectal Cancer, for current coverage guidance.

Operating Procedure 2.03.011A

Billing Rule

Report with Category III CPT code

When reporting this service, use the appropriate Category III CPT code as noted in provider guidelines.

See provider guidance and code_table for Category III CPT code reporting

Background & Evidence

Computed tomographic colonography (CTC or virtual colonoscopy) generates three-dimensional images of the colon from multiple CT x-ray slices. The examination is less time consuming and less invasive than conventional colonoscopy and does not require sedation, but it requires a full bowel preparation similar to standard colonoscopy and the colon is insufflated with air or carbon dioxide on the day of the exam. When polyps are detected with virtual colonoscopy, additional endoscopic colonoscopy is required to remove them.

Evidence summary: several studies and a meta-analysis examined diagnostic performance (sensitivity and specificity) of CTC, with variation between studies and higher sensitivity for larger polyps. The Technology Evaluation Center (TEC) criteria assessment noted that CTC did not meet TEC criteria #2-5. The U.S. Preventive Services Task Force (2002) stated that no studies have evaluated the effectiveness of CT colonography in reducing morbidity or mortality from colorectal cancer; overall, the evidence remained inconsistent and there were no studies evaluating CTC impact on patient management or disease outcomes.

Term	Definition
CTC	Computed tomographic colonography, also known as virtual colonoscopy
Virtual Colonoscopy (VC)	Imaging technology producing 3-dimensional images of the colon from CT slices; may require additional endoscopic colonoscopy for polyp removal