An update on the impact of COVID-19 on colorectal cancer screening using Medicare claims data.

87 Background: In March 2020, the Centers for Medicare & Medicaid Services (CMS) recommended delaying non-urgent procedures, including screening colonoscopies, to minimize COVID-19 transmission. This led to nationwide delays in colorectal cancer (CRC) screening, with sharp declines in 2020 and incomplete recovery by 2022. With updated Medicare claims data through 2023, we assessed trends in CRC screening utilization. Methods: We analyzed CMS claims data from 2013-2023 using CPT codes for colonoscopy, fecal occult blood test (FOBT), stool-based DNA testing, sigmoidoscopy, and barium enema. Annual claims and year-over-year (YOY) changes were evaluated. Results: From 2013-2019, total CRC screening claims were stable at about 2 million annually, with modest average YOY growth of 0.5%. Total claims declined from 2,121,034 in 2019 to 1,623,835 in 2020, a 23.4% decrease. By 2023, volumes partially recovered to 1,911,484 but remained 9.9% below 2019. Colonoscopy, accounting for 35-37% of claims pre-pandemic, declined from 736,247 to 533,972 in 2020 (27.5% decrease) but rebounded to 732,763 in 2023, nearing baseline. FOBT, once the most common modality with 1,307,054 claims in 2013, steadily declined to 485,184 in 2023, a 62.9% reduction. In contrast, stool-based DNA testing grew rapidly after its introduction in 2016, rising from 123,748 claims to 689,488 by 2023 and exceeding FOBT. Sigmoidoscopy (