I 

108TH CONGRESS 

1ST SESSION H. R. 1422

To amend title XVIII of the Social Security Act to improve patient access 

to, and utilization of, the colorectal cancer screening benefit under the 

Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 25, 2003

Mr. CARDIN (for himself, Mr. ENGLISH, Mr. RANGEL, Mr. PORTMAN, Mr. 

LEWIS of Georgia, Ms. DUNN, Mr. TOWNS, Mrs. JONES of Ohio, Mr. 

WILSON of South Carolina, Mr. GONZALEZ, Mr. STRICKLAND, and Ms. 

LORETTA SANCHEZ of California) 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 improve 

patient access to, and utilization of, the colorectal cancer 

screening benefit 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 ‘‘Colon Cancer Screen 

5 for Life Act of 2003’’. 
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1 SEC. 2. SENSE OF CONGRESS. 

2 It is the sense of Congress that—

3 (1) colorectal cancer screening tests (as defined 

4 in section 1861(pp) of the Social Security Act (42 

5 U.S.C. 1395x(pp)) covered under the medicare pro6 gram have been severely underutilized, with the 

7 Comptroller General of the United States reporting 

8 in 2000 that since coverage of such tests was imple9 mented, the percentage of beneficiaries under the 

10 medicare program receiving either a screening or a 

11 diagnostic colonoscopy has increased by only 1 per12 cent; 

13 (2) the Centers for Medicare & Medicaid Serv14 ices should encourage health care providers to use 

15 more effective screening and diagnostic health care 

16 technologies in the area of colorectal cancer screen17 ing; 

18 (3) in recent years, the Centers for Medicare & 

19 Medicaid Services has subjected colorectal cancer 

20 screening tests to some of the largest reimbursement 

21 reductions under the medicare program; 

22 (4) unlike other preventive screening tests cov23 ered under the medicare program, health care pro24 viders must consult with beneficiaries prior to fur25 nishing a screening colonoscopy in order to—
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1 (A) ascertain the medical and family his2 tory of the beneficiary; and 

3 (B) inform the beneficiary of preparatory 

4 steps that must be taken prior to the procedure; 

5 and 

6 (5) reimbursement under the medicare program 

7 is not currently available for the consultations de8 scribed in paragraph (4) despite the fact that reim9 bursement is provided under such program for simi10 lar consultations prior to a diagnostic colonoscopy. 

11 SEC. 3. INCREASE IN REIMBURSEMENT FOR COLORECTAL 

12 CANCER SCREENING AND DIAGNOSTIC 

13 TESTS. 

14 (a) IN GENERAL.—Section 1834(d) of the Social Se15 curity Act (42 U.S.C. 1395m(d)) is amended by adding 

16 at the end the following new paragraph: 

17 ‘‘(4) ENHANCED PAYMENT FOR COLORECTAL

18 CANCER SCREENING AND DIAGNOSTIC TESTS.—

19 ‘‘(A) NONFACILITY RATES.—Notwith20 standing paragraphs (2)(A) and (3)(A), the 

21 Secretary shall establish national minimum pay22 ment amounts for CPT codes 45330, 45378, 

23 45380, 45385 and HCPCS codes GO104, 

24 GO105, GO106, GO107, GO120, and GO121 

25 for items and services furnished during the last 
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1 6 months of 2003 and in subsequent years 

2 which reflect a 10 percent increase above the 

3 relative value units in effect as the nonfacility 

4 rates for such codes on June 30, 2003, with 

5 such revised payment level to apply to items 

6 and services performed in a nonfacility setting, 

7 provided, however, that such setting is con8 sistent with quality care, sound medical judg9 ment, and prevention of potential complications. 

10 ‘‘(B) FACILITY RATES.—Notwithstanding 

11 paragraphs (2)(A) and (3)(A), the Secretary 

12 shall establish national minimum payment 

13 amounts for CPT codes 45330, 45378, 45380, 

14 45385 and HCPCS codes GO104, GO105, 

15 GO106, GO107, GO120, and GO121 for items 

16 and services furnished during the last 6 months 

17 of 2003 and in subsequent years which reflect 

18 a 30 percent increase above the relative value 

19 units in effect as the facility rates for such 

20 codes on June 30, 2003, with such revised pay21 ment level to apply to items and services per22 formed in a facility setting. 

23 ‘‘(C) ANNUAL ADJUSTMENTS.—In the case 

24 of items and services furnished on or after Jan25 uary 1, 2004, the payment rates described in 
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1 subparagraphs (A) and (B) shall, subject to the 

2 minimum payment amounts established in such 

3 subparagraphs, be adjusted annually as pro4 vided in section 1848.’’. 

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

6 this section shall apply to items and services furnished on 

7 or after July 1, 2003. 

8 SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CON9 SULTATION PRIOR TO A SCREENING 

10 COLONOSCOPY OR IN CONJUNCTION WITH A 

11 BENEFICIARY’S DECISION TO OBTAIN SUCH A 

12 SCREENING. 

13 (a) COVERAGE.—Section 1861(s)(2) of the Social Se14 curity Act (42 U.S.C. 1395x(s)(2)) is amended—

15 (1) in subparagraph (U), by striking ‘‘and’’ at 

16 the end; 

17 (2) in subparagraph (V), by inserting ‘‘and’’ at 

18 the end; and 

19 (3) by adding at the end the following new sub20 paragraph: 

21 ‘‘(W) an outpatient office visit or consultation 

22 for the purpose of beneficiary education, assuring se23 lection of the proper screening test, and securing in24 formation relating to the procedure and sedation of 

25 the beneficiary, prior to a colorectal cancer screening
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1 test consisting of a screening colonoscopy or in con2 junction with the beneficiary’s decision to obtain 

3 such a screening, regardless of whether such screen4 ing is medically indicated with respect to the bene5 ficiary;’’. 

6 (b) PAYMENT.—

7 (1) IN GENERAL.—Section 1833(a)(1) of the 

8 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

9 amended—

10 (A) by striking ‘‘and’’ before ‘‘(U)’’; and 

11 (B) by inserting before the semicolon at 

12 the end the following: ‘‘, and (V) with respect 

13 to an outpatient office visit or consultation 

14 under section 1861(s)(2)(W), the amounts paid 

15 shall be 80 percent of the lesser of the actual 

16 charge or the amount established under section 

17 1848, except that no payment shall be made for 

18 such a visit or consultation if no payment would 

19 be made for a colorectal cancer screening test 

20 consisting of a screening colonoscopy for the in21 dividual furnished on the date of such visit or 

22 consultation because of the frequency limits de23 scribed in section 1834(d)(3)(E)’’. 

24 (2) PAYMENT UNDER PHYSICIAN FEE SCHED25 ULE.—Section 1848(j)(3) of the Social Security Act 
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1 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

2 ‘‘(2)(W),’’ after ‘‘(2)(S),’’. 

3 (3) REQUIREMENT FOR ESTABLISHMENT OF

4 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED5 ULE.—Section 1834(d) of the Social Security Act 

6 (42 U.S.C. 1395m(d)), as amended by section 3, is 

7 amended by adding at the end the following new 

8 paragraph: 

9 ‘‘(5) PAYMENT FOR OUTPATIENT OFFICE VISIT

10 OR CONSULTATION PRIOR TO SCREENING

11 COLONOSCOPY.—With respect to an outpatient office 

12 visit or consultation under section 1861(s)(2)(W), 

13 payment under section 1848 shall be consistent with 

14 the payment amounts for CPT codes 99203 and 

15 99243.’’. 

16 (4) FREQUENCY LIMITATION.—Section 

17 1862(a)(1) of the Social Security Act (42 U.S.C. 

18 1395y(a)(1)) is amended—

19 (A) in subparagraph (H), by striking 

20 ‘‘and’’ at the end; 

21 (B) in subparagraph (I), by striking the 

22 semicolon at the end and inserting ‘‘, and’’; and 

23 (C) by inserting after subparagraph (I) the 

24 following new subparagraph: 
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1 ‘‘(J) in the case of an outpatient office visit or 

2 consultation under section 1861(s)(2)(W), which is 

3 performed more frequently that is covered under sec4 tion 1833(a)(1)(V);’’. 

5 (c) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to items and services provided on 

7 or after July 1, 2003. 

8 SEC. 5. WAIVER OF DEDUCTIBLE FOR COLORECTAL CAN9 CER SCREENING TESTS. 

10 (a) IN GENERAL.—The first sentence of section 

11 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 

12 is amended—

13 (1) by striking ‘‘and’’ before ‘‘(6)’’; and 

14 (2) by inserting before the period at the end the 

15 following: ‘‘, and (7) such deductible shall not apply 

16 with respect to colorectal cancer screening tests (as 

17 described in section 1861(pp)(1))’’. 

18 (b) CONFORMING AMENDMENTS.—Paragraphs 

19 (2)(C)(ii) and (3)(C)(ii) of section 1834(d) of the Social 

20 Security Act (42 U.S.C. 1395m(d)) are each amended—

21 (1) by striking ‘‘DEDUCTIBLE AND’’ in the 

22 heading; and 

23 (2) in subclause (I), by striking ‘‘deductible or’’ 

24 each place it appears. 
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1 (c) EFFECTIVE DATE.—The amendment made by 

2 this section shall apply to items and services furnished on 

3 or after July 1, 2003.

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