CT Colonography Receives National Coverage

CT Colonography Receives National Coverage The Medicare Physician Fee Schedule (MPFS) for 2025 included coverage for screening CT Colonography (CTC), which had not previously been covered by Medicare. With the recent issuance of Change Request 13939 by the Centers for Medicare and Medicaid Services (CMS), all Medicare carriers now have the direction and authority to begin reimbursement for CTC.

The coverage for CTC became effective as of January 1, 2025, although carriers have until July 1, 2025, to begin to implement the policy. The service is to be billed using CPT^[1] code 74263, Computed tomographic (CT) colonography, screening, including image postprocessing. Reimbursement at the national Medicare fee schedule is $108.68 for the professional component, and $699.98 globally in an imaging center. Coinsurance and deductibles are waived for this screening exam. The professional component of the procedure is valued at 3.36 wRVU in the MPFS Final Rule for 2025, which was a slight upgrade from the Proposed Rule value of 3.22 wRVU.

At the same time as CTC was approved for reimbursement, Medicare removed coverage for barium enema colorectal cancer screening, previously billed using HCPCS^[2] codes G0106, G0120 and G0122.

Since Medicare coverage was effective at the beginning of the year, any services provided for Medicare beneficiaries during 2025 may still be billed and reimbursed under the new rules, although payment might not be forthcoming until July depending on the readiness of the particular Medicare Administrative Contractor (MAC) serving your area. In addition to Medicare, there is widespread coverage of the procedure by commercial payers including Aetna, Cigna, United Healthcare, and some Blue Shield plans.

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[1] Current Procedural Terminology (CPT) is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

[2] HCPCS is the Healthcare Common Procedure Coding System developed by the Centers for Medicare & Medicaid Services (CMS) to represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4^® (CPT-4) codes (known as HCPCS Level I codes).

Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.

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