Here are 10 recent changes to colonoscopy laws, reimbursements and recommendations from 2024 that physicians should watch going into 2025:
States expanding care
Beginning Jan. 1, Nebraska, Illinois, Kentucky and Vermont expanded access to colonoscopies that are fully covered by insurance.
Average cost
Here is a breakdown of the average cost of patient coloscopies headed into 2025. On average, a colonoscopy in the U.S. will cost patients an average of $1,608.
Leaders step up for reform
In January, 45 members of Congress, led by Rep. Debbie Dingell, D-Mich., authored a letter to the Department of Health and Human Services urging federal agencies to expand access to colorectal cancer screenings by ensuring surveillance colonoscopies are covered as preventive services. Thus far, no nationwide legislation has been passed, but lawmakers are likely to continue pushing for coverage in 2025.
New CRC tests not likely to replace colonoscopies
While a new colorectal cancer blood test that was approved by the FDA in 2024 shows promise, the American Gastroenterological Association says it's not a substitute for colonoscopy. The AGA, and other physician groups, have warned patients not to quit their regular colonoscopies in favor of other options. According to the clinical validation study, the blood-based test had an 83% sensitivity rate for colorectal cancer cancers, 90% specificity for advanced neoplasia, and a 13% sensitivity for advanced precancerous lesions.
Gaps between colonoscopies
Gastroenterology groups continue to argue over what age patients should begin screening colonoscopies, with some groups recommending 45, while others recommend 50. However, new research suggests that the frequency in which eligible patients need colonoscopies could be less. A new study suggests that the recommended 10-year interval between screening colonoscopies may be safely extended to 15 years in adults with no family history of colorectal cancer whose first colonoscopy is negative.
AI to help improve colonoscopy rates
Artificial intelligence may help engage underserved patients with colonoscopy screenings. An AI patient navigator was able to re-engage patients at New York City-based Montefiore Einstein Comprehensive Cancer Center in colonoscopy screenings, doubling completion rates in individuals in underserved populations who previously missed or avoided an appointment.
Weight loss medications could impact patient colonoscopies
Patients with adequate bowel preparation before a colonoscopy see an increase in both accuracy and safety for the procedure. However, a new study found that patients taking glucagon-like peptide-1 receptor agonists may have a significantly lower quality of bowel preparation.
CMS could change CRC screening policies
Along with a 2.8% physician pay cut, CMS is floating several changes to colorectal cancer screening policy in its proposed payment system for 2025.
Specifically, CMS is proposing to update the policy for covered colorectal screenings, adding coverage of computed tomography colonography and removing coverage of barium enemas, expanding its complete CRC screening approach to include either a Medicare-covered, blood-based biomarker test or a noninvasive stool-based test. Other updates include expanding coverage so that a follow-on colonoscopy after a positive result would not aggregate beneficiary cost-sharing, proposing removing the age-appropriate screening colonoscopy measure from the merit-based incentive program and proposing to codify its definition of CRC screening tests to include a follow-on screening colonoscopy after a positive blood-based colorectal cancer screening test.
Cloud-based colonoscopy options
Odin Medical, an affiliate of Olympus Corp., earned FDA clearance for the first cloud-based AI platform designed to detect colorectal polyps during colonoscopies.
Younger patients undergoing colonoscopy
In 2021, an advisory panel lowered the recommended age for when people should begin colon cancer screenings from 50 to 45. According to new data, there has since been a small but significant increase in screenings among younger people. This trend could continue into 2025.