I 

110TH CONGRESS 

1ST SESSION H. R. 1926 

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 

APRIL 18, 2007 

Mr. NEAL of Massachusetts (for himself, Mr. ENGLISH of Pennsylvania, Mr. 

TOWNS, Mr. LATHAM, and Mrs. MCCARTHY of New York) 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 2007’’. 

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 Pro13 gram is not currently available for the consultations 

14 described in paragraph (5) despite the fact that re15 imbursement is provided under such program for 

16 similar consultations prior to a diagnostic 

17 colonoscopy. 

18 SEC. 3. INCREASE IN PART B REIMBURSEMENT FOR 

19 COLORECTAL CANCER SCREENING AND DI20 AGNOSTIC TESTS. 

21 (a) IN GENERAL.—Section 1834(d) of the Social Se22 curity Act (42 U.S.C. 1395m(d)) is amended by adding 

23 at the end the following new paragraph: 


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1 ‘‘(4) ENHANCED PART B PAYMENT FOR

2 COLORECTAL CANCER SCREENING AND DIAGNOSTIC

3 TESTS.— 

4 ‘‘(A) NONFACILITY RATES.—Notwith5 standing paragraphs (2)(A) and (3)(A), the 

6 Secretary shall establish national minimum pay7 ment amounts for CPT codes 45378, 45380, 

8 and 45385, and HCPCS codes G0105 and 

9 GO121 for items and services furnished on or 

10 after January 1, 2008, which reflect a 10-per11 cent increase above the relative value units in 

12 effect as the nonfacility rates for such codes on 

13 December 31, 2007, with such revised payment 

14 level to apply to items and services performed 

15 in a nonfacility setting. 

16 ‘‘(B) FACILITY RATES.—Notwithstanding 

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

18 shall establish national minimum payment 

19 amounts for CPT codes 45378, 45380, and 

20 45385, and HCPCS codes G0105 and GO121 

21 for items and services furnished on or after 

22 January 1, 2008, which reflect a 30-percent in23 crease above the relative value units in effect as 

24 the facility rates for such codes on December 

25 31, 2007, with such revised payment level to 


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1 apply to items and services performed in a facil2 ity setting. 

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

4 of items and services furnished on or after Jan5 uary 1, 2008, the payment rates described in 

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

7 minimum payment amounts established in such 

8 subparagraphs, be adjusted annually as pro9 vided in section 1848.’’. 

10 (b) NO EFFECT ON HOPD PAYMENTS.—The Sec11 retary of Health and Human Services shall not take into 

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

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

14 the amount of payment for any covered OPD service under 

15 the prospective payment system for hospital outpatient de16 partment services under section 1833(t) of such Act (42 

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

18 SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CON19 SULTATION PRIOR TO A SCREENING 

20 COLONOSCOPY OR IN CONJUNCTION WITH A 

21 BENEFICIARY’S DECISION TO OBTAIN SUCH A 

22 SCREENING. 

23 (a) COVERAGE.—Section 1861(s)(2) of the Social Se24 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 


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

2 the end; 

3 (2) in subparagraph (AA), by inserting ‘‘and’’ 

4 at the end; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(BB) an outpatient office visit or con8 sultation for the purpose of beneficiary edu9 cation, assuring selection of the proper screen10 ing test, and securing information relating to 

11 the procedure and sedation of the beneficiary, 

12 prior to a colorectal cancer screening test con13 sisting of a screening colonoscopy or in conjunc14 tion with the beneficiary’s decision to obtain 

15 such a screening, regardless of whether such 

16 screening is medically indicated with respect to 

17 the beneficiary;’’. 

18 (b) PAYMENT.— 

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

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

21 amended— 

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

23 (B) by inserting before the semicolon at 

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

25 to an outpatient office visit or consultation 


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1 under section 1861(s)(2)(BB), the amounts 

2 paid shall be 80 percent of the lesser of the ac3 tual charge or the amount established under 

4 section 1848’’. 

5 (2) PAYMENT UNDER PHYSICIAN FEE SCHED6 ULE.—Section 1848(j)(3) of the Social Security Act 

7 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

8 ‘‘(2)(BB),’’ after’’(2)(AA),’’. 

9 (3) REQUIREMENT FOR ESTABLISHMENT OF

10 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED11 ULE.—Section 1834(d) of the Social Security Act 

12 (42 U.S.C. 1395m(d)), as amended by section 3, is 

13 amended by adding at the end the following new 

14 paragraph: 

15 ‘‘(5) PAYMENT FOR OUTPATIENT OFFICE VISIT

16 OR CONSULTATION PRIOR TO SCREENING

17 COLONOSCOPY.—With respect to an outpatient office 

18 visit or consultation under section 1861(s)(2)(BB), 

19 payment under section 1848 shall be consistent with 

20 the payment amounts for CPT codes 99203 and 

21 99243.’’. 

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

23 this section shall apply to items and services provided on 

24 or after January 1, 2008. 


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1 SEC. 5. TECHNICAL AMENDMENT TO WAIVER OF DEDUCT2 IBLE FOR COLORECTAL CANCER SCREENING 

3 TESTS. 

4 (a) IN GENERAL.—Section 1833(b)(8) of the Social 

5 Security Act (42 U.S.C. 1395l(b)(8)), as inserted by sec6 tion 5113(a) of the Deficit Reduction Act of 2005 (Public 

7 Law 109-171), is amended by inserting ‘‘, regardless of 

8 the code applied, a particular diagnosis, or whether a con9 nected procedure is performed’’ after ‘‘1861(pp)(1))’’. 

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

11 this section shall apply to items and services furnished on 

12 or after January 1, 2008. 

Æ 


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