CT colonography has been shown to be an effective method to screen for colorectal cancer. However, at present, full endorsement and reimbursement for screening CT colonography, particularly by the US Preventive Services Task Force and CMS, respectively, are absent, so this screening option is infrequently used, and optical colonoscopy remains the de facto standard screening option. The authors summarize the past accomplishments that led to the current state of reimbursement and outline the remaining challenges and road to full acceptance and reimbursement of screening CT colonography nationally.