I 

114TH CONGRESS 

2D SESSION H. R. 4632 

To amend title XVIII of the Social Security Act to cover screening computed 

tomography colonography as a colorectal cancer screening test under 

the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 25, 2016 

Mr. WENSTRUP (for himself and Mr. DANNY K. DAVIS of Illinois) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committee on Ways and Means, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to cover 

screening computed tomography colonography as a 

colorectal cancer screening test under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘CT Colonography 

5 Screening for Colorectal Cancer Act of 2016’’. 


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1 SEC. 2. COVERAGE OF COMPUTED TOMOGRAPHY 

2 COLONOGRAPHY SCREENING AS A 

3 COLORECTAL CANCER SCREENING TEST 

4 UNDER MEDICARE. 

5 (a) IN GENERAL.—Section 1861(pp)(1) of the Social 

6 Security Act (42 U.S.C. 1395x(pp)(1)) is amended— 

7 (1) by redesignating subparagraph (D) as sub8 paragraph (E); and 

9 (2) by inserting after subparagraph (C) the fol10 lowing new subparagraph: 

11 ‘‘(D) Screening computed tomography 

12 colonography.’’. 

13 (b) FREQUENCY LIMITS AND PAYMENT.—Section 

14 1834(d) of such Act (42 U.S.C. 1395m(d)) is amended 

15 by adding at the end the following new paragraph: 

16 ‘‘(4) SCREENING COMPUTED TOMOGRAPHY

17 COLONOGRAPHY.— 

18 ‘‘(A) FEE SCHEDULE.—With respect to a 

19 colorectal cancer screening test consisting of 

20 screening computed tomography colonography, 

21 subject to subparagraph (B), payment under 

22 section 1848 shall be consistent with payment 

23 under such section for similar or related serv24 ices. 

25 ‘‘(B) PAYMENT LIMIT.—In the case of 

26 screening computed tomography colonography, 


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1 payment under this part shall not exceed such 

2 amount as the Secretary specifies, based upon 

3 rates recognized for diagnostic computed to4 mography colonography. 

5 ‘‘(C) FACILITY PAYMENT LIMIT.—Notwith6 standing any other provision of this title, in the 

7 case of an individual who receives screening 

8 computed tomography colonography— 

9 ‘‘(i) in computing the amount of any 

10 applicable coinsurance, the computation of 

11 such coinsurance shall be based upon the 

12 fee schedule under which payment is made 

13 for the services; and 

14 ‘‘(ii) the amount of such coinsurance 

15 shall not exceed 25 percent of the payment 

16 amount under the fee schedule described in 

17 subparagraph (A). 

18 ‘‘(D) FREQUENCY LIMIT.—No payment 

19 may be made under this part for a colorectal 

20 cancer screening test consisting of a screening 

21 computed tomography colonography— 

22 ‘‘(i) if the individual is under 50 years 

23 of age; or 

24 ‘‘(ii)(I) in the case of individuals at 

25 high risk for colorectal cancer, if the proceVerDate Sep 11 2014 01:54 Feb 27, 2016 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4632.IH H4632

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1 dure is performed within the 23 months 

2 after a previous screening computed to3 mography colonography or a previous 

4 screening colonoscopy; or 

5 ‘‘(II) in the case of an individual who 

6 is not at high risk for colorectal cancer, if 

7 the procedure is performed within the 119 

8 months after a previous screening 

9 colonoscopy or within the 59 months after 

10 a previous screening flexible sigmoidoscopy 

11 or a previous screening computed tomog12 raphy colonography.’’. 

13 (c) CONFORMING FREQUENCY LIMITS FOR OTHER

14 COLORECTAL CANCER SCREENING TESTS.— 

15 (1) SCREENING FLEXIBLE SIGMOIDOSCOPY.— 

16 Paragraph (2)(E)(ii) of section 1834(d) of the Social 

17 Security Act (42 U.S.C. 1395m(d)) is amended by 

18 inserting ‘‘or screening computed tomography 

19 colonography’’ after ‘‘previous screening flexible 

20 sigmoidoscopy’’. 

21 (2) SCREENING COLONOSCOPY.—Paragraph 

22 (3)(E) of such section is amended— 

23 (A) by inserting ‘‘or screening computed 

24 tomography colonography’’ after ‘‘23 months 

25 after a previous screening colonoscopy’’; and 


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1 (B) by inserting ‘‘or screening computed 

2 tomography colonography’’ after ‘‘screening 

3 flexible sigmoidoscopy’’. 

4 (d) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to items and services furnished on 

6 or after January 1, 2017. 

7 SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOG8 RAPHY COLONOGRAPHY FROM SPECIAL 

9 RULE ON PAYMENT FOR IMAGING SERVICES. 

10 (a) IN GENERAL.—Section 1848(b)(4)(B) of the So11 cial Security Act (42 U.S.C. 1395w–4(b)(4)(B)) is amend12 ed by inserting ‘‘and screening computed tomography 

13 colonography’’ after ‘‘diagnostic and screening mammog14 raphy’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 subsection (a) shall apply to items and services furnished 

17 on or after January 1, 2017. 

18 SEC. 4. REPORTS ON THE STATUS OF COVERING COM19 PUTED TOMOGRAPHY COLONOGRAPHY AS A 

20 COLORECTAL CANCER SCREENING TEST 

21 UNDER MEDICARE. 

22 (a) PRELIMINARY REPORT.—Not later than 90 days 

23 after the date of the enactment of this Act, the Secretary 

24 of Health and Human Services shall submit a preliminary 

25 report to Congress on the status of coverage of computed 


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1 tomography colonography as a colorectal cancer screening 

2 test under the Medicare program under title XVIII of the 

3 Social Security Act, including the extent to which such 

4 coverage as required by the amendments made by sections 

5 2 and 3 has been implemented. 

6 (b) ANNUAL REPORT.—Not later than September 30 

7 of each fiscal year during the 5-year period beginning with 

8 fiscal year 2018, the Secretary shall submit to the Con9 gress, a status report on the following: 

10 (1) The impact of screening computed tomog11 raphy colonography on the change in colorectal can12 cer screening compliance of Medicare beneficiaries. 

13 (2) The various utilization rates with respect to 

14 Medicare beneficiaries for each available colorectal 

15 cancer screening option before and after the avail16 ability of and coverage of screening computed to17 mography colonography under the Medicare program 

18 pursuant to the enactment of this Act, including— 

19 (A) by initial CRC screening performed 

20 with respect to a Medicare beneficiary per year, 

21 including the age of the beneficiary when the 

22 initial screening was performed; and 

23 (B) by follow-on screening performed, 

24 whereby the analysis demonstrates to what ex25 tent screening computed tomography 


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1 colonography was used as a substitute for a 

2 previous screening procedure. 

3 (3) Access to screening computed tomography 

4 colonography by Medicare beneficiaries, especially in 

5 rural areas or underserved populations, before and 

6 after the date of implementation of coverage of such 

7 screening benefit under the Medicare program pur8 suant to the enactment of this Act. 

9 (4) Recommendations for such legislation and 

10 administrative action as the Secretary determines 

11 appropriate to implement this Act. 

Æ 


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