II 

109TH CONGRESS 

1ST SESSION S. 1010 

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 SENATE OF THE UNITED STATES 

MAY 12, 2005 

Mr. SANTORUM (for himself, Mr. LIEBERMAN, Ms. COLLINS, Mr. BINGAMAN, 

Mr. NELSON of Nebraska, Ms. SNOWE, Mr. GRAHAM, Mr. JEFFORDS, 

Ms. LANDRIEU, and Mr. DORGAN) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

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 2005’’. 

6 SEC. 2. SENSE OF CONGRESS. 

7 It is the sense of Congress that— 
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1 (1) colorectal cancer screening tests (as defined 

2 in section 1861(pp)(1) of the Social Security Act (42 

3 U.S.C. 1395x(pp)(1)) covered under the medicare 

4 program have been severely underutilized, with the 

5 Comptroller General of the United States reporting 

6 in 2000 that since coverage of such tests was imple7 mented, the percentage of beneficiaries under the 

8 medicare program receiving either a screening or a 

9 diagnostic colonoscopy has increased by only 1 per10 cent; 

11 (2) in recognition of the need to improve rates 

12 of colorectal cancer screening in the medicare pro13 gram, Congress enacted provisions in the Medicare 

14 Prescription Drug, Improvement, and Modernization 

15 Act of 2003 to require physicians to provide a refer16 ral for colorectal cancer screening as part of the new 

17 initial preventive physical examination, beginning 

18 January 1, 2005; 

19 (3) the Centers for Medicare & Medicaid Serv20 ices should encourage health care providers to use 

21 more effective screening and diagnostic health care 

22 technologies in the area of colorectal cancer screen23 ing; 

24 (4) in recent years, the Centers for Medicare & 

25 Medicaid Services has subjected colorectal cancer 
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1 screening tests to some of the largest reimbursement 

2 reductions under the medicare program; 

3 (5) unlike other preventive screening tests cov4 ered under the medicare program, health care pro5 viders must consult with beneficiaries prior to fur6 nishing a screening colonoscopy in order to— 

7 (A) ascertain the medical and family his8 tory of the beneficiary; and 

9 (B) inform the beneficiary of preparatory 

10 steps that must be taken prior to the procedure; 

11 and 

12 (6) reimbursement under the medicare program 

13 is not currently available for the consultations de14 scribed in paragraph (5) despite the fact that reim15 bursement is provided under such program for simi16 lar consultations prior to a diagnostic colonoscopy. 

17 SEC. 3. INCREASE IN PART B REIMBURSEMENT FOR 

18 COLORECTAL CANCER SCREENING AND DI19 AGNOSTIC TESTS. 

20 (a) IN GENERAL.—Section 1834(d) of the Social Se21 curity Act (42 U.S.C. 1395m(d)) is amended by adding 

22 at the end the following new paragraph: 

23 ‘‘(4) ENHANCED PART B PAYMENT FOR

24 COLORECTAL CANCER SCREENING AND DIAGNOSTIC

25 TESTS.— 
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1 ‘‘(A) NONFACILITY RATES.—Notwith2 standing paragraphs (2)(A) and (3)(A), the 

3 Secretary shall establish national minimum pay4 ment amounts for CPT codes 45378, 45380, 

5 and 45385, and HCPCS codes G0105 and 

6 GO121 for items and services furnished on or 

7 after January 1, 2006, which reflect a 10-per8 cent increase above the relative value units in 

9 effect as the nonfacility rates for such codes on 

10 December 31, 2005, with such revised payment 

11 level to apply to items and services performed 

12 in a nonfacility setting. 

13 ‘‘(B) FACILITY RATES.—Notwithstanding 

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

15 shall establish national minimum payment 

16 amounts for CPT codes 45378, 45380, and 

17 45385, and HCPCS codes G0105 and GO121 

18 for items and services furnished on or after 

19 January 1, 2006, which reflect a 30-percent in20 crease above the relative value units in effect as 

21 the facility rates for such codes on December 

22 31, 2005, with such revised payment level to 

23 apply to items and services performed in a facil24 ity setting. 
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1 ‘‘(C) ANNUAL ADJUSTMENTS.—In the case 

2 of items and services furnished on or after Jan3 uary 1, 2006, the payment rates described in 

4 subparagraphs (A) and (B) shall, subject to the 

5 minimum payment amounts established in such 

6 subparagraphs, be adjusted annually as pro7 vided in section 1848.’’. 

8 (b) NO EFFECT ON HOPD PAYMENTS.—The Sec9 retary of Health and Human Services shall not take into 

10 account the provisions of section 1834(d)(4) of the Social 

11 Security Act, as added by subsection (a), in determining 

12 the amount of payment for any covered OPD service under 

13 the prospective payment system for hospitals outpatient 

14 department services under section 1833(t) of such Act (42 

15 U.S.C. 1395l(t)). 

16 SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CON17 SULTATION PRIOR TO A SCREENING 

18 COLONOSCOPY OR IN CONJUNCTION WITH A 

19 BENEFICIARY’S DECISION TO OBTAIN SUCH A 

20 SCREENING. 

21 (a) COVERAGE.—Section 1861(s)(2) of the Social Se22 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

23 (1) in subparagraph (Y), by striking ‘‘and’’ at 

24 the end; 
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1 (2) in subparagraph (Z), by inserting ‘‘and’’ at 

2 the end; and 

3 (3) by adding at the end the following new sub4 paragraph: 

5 ‘‘(AA) an outpatient office visit or con6 sultation for the purpose of beneficiary edu7 cation, assuring selection of the proper screen8 ing test, and securing information relating to 

9 the procedure and sedation of the beneficiary, 

10 prior to a colorectal cancer screening test con11 sisting of a screening colonoscopy or in conjunc12 tion with the beneficiary’s decision to obtain 

13 such a screening, regardless of whether such 

14 screening is medically indicated with respect to 

15 the beneficiary;’’. 

16 (b) PAYMENT.— 

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

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

19 amended— 

20 (A) by striking ‘‘and’’ before ‘‘(V)’’; and 

21 (B) by inserting before the semicolon at 

22 the end the following: ‘‘, and (W) with respect 

23 to an outpatient office visit or consultation 

24 under section 1861(s)(2)(AA), the amounts 

25 paid shall be 80 percent of the lesser of the ac-
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1 tual charge or the amount established under 

2 section 1848’’. 

3 (2) PAYMENT UNDER PHYSICIAN FEE SCHED4 ULE.—Section 1848(j)(3) of the Social Security Act 

5 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

6 ‘‘(2)(AA),’’ after ‘‘(2)(W),’’. 

7 (3) REQUIREMENT FOR ESTABLISHMENT OF

8 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED9 ULE.—Section 1834(d) of the Social Security Act 

10 (42 U.S.C. 1395m(d)), as amended by section 3, is 

11 amended by adding at the end the following new 

12 paragraph: 

13 ‘‘(5) PAYMENT FOR OUTPATIENT OFFICE VISIT

14 OR CONSULTATION PRIOR TO SCREENING

15 COLONOSCOPY.—With respect to an outpatient office 

16 visit or consultation under section 1861(s)(2)(AA), 

17 payment under section 1848 shall be consistent with 

18 the payment amounts for CPT codes 99203 and 

19 99243.’’. 

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

21 this section shall apply to items and services provided on 

22 or after January 1, 2006. 
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1 SEC. 5. WAIVER OF DEDUCTIBLE FOR COLORECTAL CAN2 CER SCREENING TESTS. 

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

4 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 

5 is amended— 

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

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

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

9 with respect to colorectal cancer screening tests (as 

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

11 (b) CONFORMING AMENDMENTS.—Paragraphs 

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

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

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

15 heading; and 

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

17 each place it appears. 

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

19 this section shall apply to items and services furnished on 

20 or after January 1, 2006.

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