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 U.S. Centers for Medicare and Medicaid Services (CMS), all Medicare carriers now have the direction and authority to begin reimbursement for CTC.
Sandy Coffta
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 code 74263, 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 CTC was approved for reimbursement, Medicare removed coverage for barium enema colorectal cancer screening, previously billed using Healthcare Common Procedure Coding System (HCPCS) 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.
Sandy Coffta is the vice president of client services at Healthcare Administrative Partners.
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