II 

111TH CONGRESS 

1ST SESSION S. 1511 

To amend titles XVIII and XIX of the Social Security Act to improve 

awareness and access to colorectal cancer screening tests under the 

Medicare and Medicaid programs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 23, 2009 

Mr. CARDIN (for himself and Mr. GRAHAM) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to improve awareness and access to colorectal cancer 

screening tests under the Medicare and Medicaid programs, and for other purposes. 

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 ‘‘Supporting ColoRectal 

5 Examination and Education Now (SCREEN) Act of 

6 2009’’. 


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1 SEC. 2. FINDINGS AND SENSE OF CONGRESS. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) A majority of the deaths and costs associ5 ated with colorectal cancer, the second leading cause 

6 of cancer deaths in the United States, are avoidable 

7 through timely preventive screening, including 

8 colonoscopy. 

9 (2) The United States Preventive Services Task 

10 Force provides its only grade ‘‘A’’ recommendation 

11 of cancer screenings for colorectal interventions. 

12 (3) Colorectal cancer screening test rates are 

13 far too low, with only 50 percent of recommended 

14 populations receiving colorectal cancer screening 

15 tests, and rates of such screening tests among mi16 norities and those without insurance lag consider17 ably. 

18 (4) The colorectal cancer screening benefit 

19 under the Medicare Program under title XVIII of 

20 the Social Security Act is severely underutilized. 

21 (5) Numerous barriers for patients, commu22 nities, and health care providers detrimentally affect 

23 the utilization of colorectal cancer screening tests. 

24 Such barriers include patient knowledge, coinsurance 

25 burdens, restrictions on Medicare coverage for an ofVerDate Nov 24 2008 22:37 Jul 24, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1511.IS S1511

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1 fice visit prior to a screening colonoscopy, and reduc2 tions in Medicare reimbursement. 

3 (b) SENSE OF CONGRESS.—It is the sense of Con4 gress that— 

5 (1) if legislation to provide health insurance 

6 coverage, public or private, to persons under the age 

7 of 65, is enacted, coverage of colorectal cancer 

8 screening tests and the provisions of this Act should 

9 be included as part of any basic benefit package re10 quired under such legislation; and 

11 (2) Congress, Federal agencies, State and local 

12 governments, health care providers, and patient 

13 groups should make a concerted and sustained effort 

14 to increase the rate of colorectal cancer screening 

15 tests. 

16 SEC. 3. COMMUNITY AND PATIENT INTERVENTIONS. 

17 (a) GRANT PROGRAM TO INCREASE COLORECTAL

18 CANCER AWARENESS, SCREENING, AND TREATMENT.— 

19 (1) DEFINITIONS.—In this subsection: 

20 (A) COLORECTAL CANCER SCREENING

21 TESTS.—The term ‘‘colorectal cancer screening 

22 test’’ has the meaning given such term in sec23 tion 1861(pp)(1) of the Social Security Act (42 

24 U.S.C. 1395x(pp)(1)). 


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1 (B) INDIAN TRIBE.—The term ‘‘Indian 

2 tribe’’ has the meaning given such term in sec3 tion 4 of the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450b). 

5 (C) SECRETARY.—The term ‘‘Secretary’’ 

6 means the Secretary of Health and Human 

7 Services, acting through the Director of the 

8 Centers for Disease Control and Prevention. 

9 (D) STATE.—The term ‘‘State’’ means— 

10 (i) a State; and 

11 (ii) the District of Columbia. 

12 (2) GRANTS AUTHORIZED.—The Secretary is 

13 authorized to make grants to States and Indian 

14 tribes for colorectal health programs. Such programs 

15 may include the following: 

16 (A) Provide colorectal cancer screening 

17 tests, including colonoscopy, to individuals who 

18 are over 50 years of age or who are determined 

19 to be at high risk for such cancer. 

20 (B) Provide case management and refer21 rals for medical treatment for individuals who 

22 are provided colorectal cancer screening tests 

23 under the program. 

24 (C) Programs to ensure that individuals 

25 who are provided colorectal cancer screening 


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1 tests under the program receive the full con2 tinuum of follow up and cancer care, as appro3 priate. 

4 (D) Activities to improve the education, 

5 training, and skills of health professionals in 

6 the detection and treatment of colorectal can7 cer. 

8 (E) The development and dissemination of 

9 public information and education programs— 

10 (i) for the detection and treatment of 

11 colorectal cancer; and 

12 (ii) promoting the benefits of receiving 

13 colorectal cancer screening tests through 

14 the program. 

15 (3) PRIORITY.—In making grants under para16 graph (2), the Secretary shall give priority to States 

17 and Indian tribes that will use grant funds to pro18 vide colorectal cancer screening tests to low-income 

19 individuals who lack adequate health insurance cov20 erage with respect to such screening. 

21 (4) EXISTING FUNDING AUTHORITY.—The Sec22 retary shall make a grant under this section under 

23 an existing funding authority. 

24 (b) BENEFICIARY REMINDERS FOR INCREASING

25 COLORECTAL CANCER SCREENING TESTS.— 


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1 (1) DEFINITIONS.—In this subsection: 

2 (A) COLORECTAL CANCER SCREENING

3 TESTS.—The term ‘‘colorectal cancer screening 

4 test’’ has the meaning given such term in sec5 tion 1861(pp)(1) of the Social Security Act (42 

6 U.S.C. 1395x(pp)(1)). 

7 (B) MEDICARE BENEFICIARY.—The term 

8 ‘‘Medicare beneficiary’’ means an individual en9 titled to, or enrolled for, benefits under part A 

10 of title XVIII of the Social Security Act and en11 rolled for benefits under part B of such title. 

12 (C) SECRETARY.—The term ‘‘Secretary’’ 

13 means the Secretary of Health and Human 

14 Services. 

15 (2) ANNUAL NOTIFICATION UNDER THE MEDI16 CARE PROGRAM.—The Secretary shall establish a 

17 program under which all Medicare beneficiaries are 

18 notified annually about the coverage of colorectal 

19 cancer screening tests under the Medicare program 

20 under title XVIII of the Social Security Act. Under 

21 the program, such notification— 

22 (A) may be provided through direct mail or 

23 direct electronic communications; and 

24 (B) may accompany other information cur25 rently provided to such beneficiaries, including 


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1 marketing materials or information provided to 

2 enrollees by Medicare Advantage organizations 

3 under section 1852(c)(1) of the Social Security 

4 Act (42 U.S.C. 1395w–22) and information 

5 provided by PDP sponsors under section 

6 1860D–4(a)(1) of such Act (42 U.S.C. 1395w– 

7 104(a)(1)). 

8 (3) STATE PLAN AMENDMENT UNDER MED9 ICAID.— 

10 (A) IN GENERAL.—Section 1902(a) of the 

11 Social Security Act (42 U.S.C. 1396a(a)), as 

12 amended by section 5006(e)(2)(A) of division B 

13 of the American Recovery and Reinvestment 

14 Act of 2009 (Public Law 111–5), is amended— 

15 (i) in paragraph (72), by striking 

16 ‘‘and’’ at the end; 

17 (ii) in paragraph (73)(B), by striking 

18 the period at the end and inserting ‘‘; 

19 and’’; and 

20 (iii) by inserting after paragraph (73), 

21 the following new paragraph: 

22 ‘‘(74) if the State has elected to provide medical 

23 assistance described in section 1905(a)(13) and such 

24 assistance includes colorectal cancer screening tests, 

25 provide for the establishment of a program under 


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1 which individuals at risk for colon cancer, including 

2 minorities who are identified as at high-risk for 

3 colon cancer, who are over an age that the Secretary 

4 determines appropriate (based on the recommenda5 tions of appropriate entities, including the United 

6 States Preventive Services Task Force and appro7 priate medical specialty societies) are provided a no8 tification of the availability of medical assistance for 

9 colorectal cancer screening tests and a reminder re10 garding the benefits of such tests.’’. 

11 (B) EFFECTIVE DATE.— 

12 (i) IN GENERAL.—Except as provided 

13 in clause (ii), the amendments made by 

14 this paragraph take effect on January 1, 

15 2011. 

16 (ii) EXTENSION OF EFFECTIVE DATE

17 FOR STATE LAW AMENDMENT.—In the 

18 case of a State plan under title XIX of the 

19 Social Security Act (42 U.S.C. 1396 et 

20 seq.) which the Secretary of Health and 

21 Human Services determines requires State 

22 legislation in order for the plan to meet the 

23 additional requirements imposed by the 

24 amendments made by this paragraph, the 

25 State plan shall not be regarded as failing 


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1 to comply with the requirements of such 

2 title solely on the basis of its failure to 

3 meet these additional requirements before 

4 the first day of the first calendar quarter 

5 beginning after the close of the first reg6 ular session of the State legislature that 

7 begins after the date of enactment of this 

8 Act. For purposes of the previous sentence, 

9 in the case of a State that has a 2-year 

10 legislative session, each year of the session 

11 is considered to be a separate regular ses12 sion of the State legislature. 

13 SEC. 4. ELIMINATION OF COINSURANCE FOR COLORECTAL 

14 CANCER SCREENING TESTS. 

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

16 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

17 (1) by striking ‘‘and’’ before ‘‘(W)’’; and 

18 (2) by inserting before the semicolon at the end 

19 the following: ‘‘, and (X) with respect to colorectal 

20 cancer screening tests (as defined in subsection 

21 (pp)), the amount paid shall be 100 percent of the 

22 lesser of the actual charge for the services or the 

23 amount determined under the fee schedule that ap24 plies to such tests under this part’’. 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) SCREENING SIGMOIDOSCOPIES AND

2 COLONOSCOPIES.—Section 1834(d) of the Social Se3 curity Act (42 U.S.C. 1395m(d)) is amended— 

4 (A) in paragraph (2)— 

5 (i) in subparagraph (A), by inserting 

6 ‘‘, except that payment for such tests 

7 under such section shall be 100 percent of 

8 the payment determined under such sec9 tion for such tests’’ before the period at 

10 the end; and 

11 (ii) in subparagraph (C)— 

12 (I) by striking clause (ii); and 

13 (II) in clause (i)— 

14 (aa) by striking ‘‘(i) IN GEN15 ERAL.—Notwithstanding’’ and 

16 inserting ‘‘Notwithstanding’’; 

17 (bb) by redesignating sub18 clauses (I) and (II) as clauses (i) 

19 and (ii), respectively, and moving 

20 such clauses and the flush matter 

21 following such clauses 2 ems to 

22 the left; and 

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1 nated, by inserting ‘‘100 percent 

2 of’’ after ‘‘based on’’; and 

3 (B) in paragraph (3)— 

4 (i) in subparagraph (A), by inserting 

5 ‘‘, except that payment for such tests 

6 under such section shall be 100 percent of 

7 the payment determined under such sec8 tion for such tests’’ before the period at 

9 the end; and 

10 (ii) in subparagraph (C)— 

11 (I) by striking clause (ii); and 

12 (II) in clause (i)— 

13 (aa) by striking ‘‘(i) IN GEN14 ERAL.—Notwithstanding’’ and 

15 inserting ‘‘Notwithstanding’’; and 

16 (bb) by inserting ‘‘100 per17 cent of’’ after ‘‘based on’’. 

18 (2) OUTPATIENT HOSPITAL SETTINGS.—Section 

19 1833(t) of the Social Security Act (42 U.S.C. 

20 1395l(t)) is amended— 

21 (A) in paragraph (4)(C), by striking 

22 ‘‘paragraph (8)(C)’’ and inserting ‘‘subpara23 graphs (C) and (F) of paragraph (8)’’; and 

24 (B) in paragraph (8), by adding at the end 

25 the following new subparagraph: 


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1 ‘‘(F) NO COPAYMENT FOR COLORECTAL

2 CANCER SCREENING TESTS.—The copayment 

3 amount that would otherwise apply under this 

4 subsection to colorectal cancer screening tests 

5 (as defined in section 1861(pp)) shall be re6 duced to zero.’’. 

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

8 this section shall apply to items and services furnished on 

9 or after January 1, 2010. 

10 SEC. 5. MEDICARE ADVANTAGE REPORTING REQUIRE11 MENTS. 

12 (a) IN GENERAL.—Section 1857(e) of the Social Se13 curity Act (42 U.S.C. 1395w–27(e)) is amended by adding 

14 at the end the following new paragraph: 

15 ‘‘(4) ANNUAL REPORTING REGARDING

16 COLORECTAL CANCER SCREENING TESTS.— 

17 ‘‘(A) IN GENERAL.—Not later than 6 

18 months after the date of enactment of this 

19 paragraph and annually thereafter, contract 

20 under this section with an MA organization 

21 shall require the organization to submit to the 

22 Secretary an annual report on the following: 

23 ‘‘(i) The coverage of colorectal cancer 

24 screening tests (as defined in section 

25 1861(pp)) under each MA plan offered by 


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1 the organization, including the level of any 

2 coinsurance or copayments applicable for 

3 enrollees under the plan. 

4 ‘‘(ii) Any educational outreach the or5 ganization provides to enrollees, providers 

6 of services, and suppliers with respect to 

7 such tests. 

8 ‘‘(iii) Any pay-for-performance incen9 tives under MA plans offered by the orga10 nization for providers of services and sup11 pliers with respect to such tests, or any 

12 other financial-sharing program with pro13 viders of services and suppliers with re14 spect to such tests. 

15 ‘‘(iv) The total number of enrollees 

16 furnished such tests during the preceding 

17 year, listed according to the specific test 

18 furnished, the type of facility in which the 

19 test was furnished, and the gender and 

20 race of the enrollees to whom such tests 

21 were furnished. 

22 ‘‘(B) REPORT TO CONGRESS AND PUBLIC

23 AVAILABILITY.— 

24 ‘‘(i) REPORT.—The Secretary shall 

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1 taining information submitted in the an2 nual reports under subparagraph (A). 

3 ‘‘(ii) PUBLIC AVAILABILITY.—The 

4 Secretary shall make such information 

5 available to the public, including by posting 

6 such information on the Internet website of 

7 the Centers for Medicare & Medicaid Serv8 ices.’’. 

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

10 this section shall apply to contracts entered into on or 

11 after January 1, 2011. 

12 SEC. 6. PROVIDER INTERVENTIONS. 

13 (a) IN GENERAL.—Section 1834(d) of the Social Se14 curity Act (42 U.S.C. 1395m(d)) is amended by adding 

15 at the end the following new paragraph: 

16 ‘‘(4) PREVENTIVE SERVICE PAYMENT MODIFIED

17 FOR CERTAIN COLORECTAL CANCER SCREENING

18 TESTS.— 

19 ‘‘(A) NATIONAL MINIMUM STANDARDS.— 

20 The Secretary, in consultation with the Insti21 tute of Medicine, shall establish a national min22 imum standard for basic knowledge, training, 

23 continuing education, and documentation for 

24 suppliers who furnish colorectal cancer screen25 ing tests (as defined in subsection (pp)). For 


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1 purposes of this paragraph, a supplier shall be 

2 deemed to meet such national minimum stand3 ards if the supplier is certified in gastro4 enterology by the American Board of Internal 

5 Medicine. 

6 ‘‘(B) PREVENTIVE SERVICE PAYMENT

7 MODIFIER.— 

8 ‘‘(i) DETERMINATION OF RATE

9 GOALS.—The Secretary, in consultation 

10 with the United States Preventive Services 

11 Task Force, the Institute of Medicine 

12 Colorectal Cancer Working Group, and 

13 other clinical advisors as determined ap14 propriate by the Secretary, shall determine 

15 age-based goal rates for colorectal cancer 

16 screening tests (as so defined) to be met or 

17 exceeded for beneficiaries under this part 

18 not later than July 1, 2010. Such age19 based goal rates shall be consistent with 

20 the rates of screening for beneficiaries with 

21 respect to other cancer screening tests 

22 (such as screening mammography and cer23 vical cancer screening). 

24 ‘‘(ii) ESTABLISHMENT OF PREVEN25 TIVE SERVICE MODIFIER FOR QUALIFIED


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1 COLORECTAL CANCER SCREENING

2 TESTS.— 

3 ‘‘(I) IN GENERAL.—The Sec4 retary shall establish an upward pre5 ventive service payment modifier for 

6 qualifying colorectal cancer screening 

7 tests furnished on or after January 1, 

8 2010, which reflects the annual deter9 mination by the Secretary of the ap10 propriate amount of additional pay11 ment (not less than 10 percent of the 

12 amount of payment otherwise pro13 vided) sufficient to increase the rate 

14 of colorectal cancer screening tests 

15 furnished under this part to the goal 

16 rates determined under clause (i). The 

17 Secretary shall update such modified 

18 on an annual basis, taking into con19 sideration the rate of colorectal cancer 

20 screening tests furnished under this 

21 part during the preceding year and 

22 such goal rates. 

23 ‘‘(II) QUALIFYING COLORECTAL

24 CANCER SCREENING TESTS.—For 

25 purposes of subclause (I), the term 


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1 ‘qualifying colorectal cancer screening 

2 tests’ means a colorectal cancer 

3 screening test furnished by a supplier 

4 who meets the national minimum 

5 standards established under subpara6 graph (A) (as determined by the Sec7 retary).’’. 

8 (b) OUTPATIENT SETTINGS.—Section 1833(t) of the 

9 Social Security Act (42 U.S.C. 1395l(t)) is amended by 

10 adding at the end the following new paragraph: 

11 ‘‘(18) IN GENERAL.— 

12 ‘‘(A) NATIONAL MINIMUM STANDARDS.— 

13 The Secretary, in consultation with the Insti14 tute of Medicine, shall establish a national min15 imum standard for basic knowledge, training, 

16 continuing education, and documentation for 

17 hospitals in outpatient settings which furnish 

18 colorectal cancer screening tests (as defined in 

19 subsection (pp)). For purposes of this para20 graph, a hospital shall be deemed to meet such 

21 national minimum standards if the hospital is 

22 certified by the Joint Commission on the Ac23 creditation of Healthcare Organizations, the Ac24 creditation Association for Ambulatory Health 


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1 Care, or other accreditation body designated by 

2 the Secretary. 

3 ‘‘(B) PREVENTIVE SERVICE PAYMENT

4 MODIFIER.— 

5 ‘‘(i) DETERMINATION OF RATE

6 GOALS.—The Secretary, in consultation 

7 with the United States Preventive Services 

8 Task Force, the Institute of Medicine 

9 Colorectal Cancer Working Group, and 

10 other clinical advisors as determined ap11 propriate by the Secretary, shall determine 

12 age-based goal rates for colorectal cancer 

13 screening tests (as so defined) to be met or 

14 exceeded for beneficiaries under this part 

15 not later than July 1, 2010. Such age16 based goal rates shall be consistent with 

17 the rates of screening for beneficiaries with 

18 respect to other cancer screening tests 

19 (such as screening mammography and cer20 vical cancer screening). 

21 ‘‘(ii) ESTABLISHMENT OF PREVEN22 TIVE SERVICE MODIFIER FOR QUALIFIED

23 COLORECTAL CANCER SCREENING

24 TESTS.— 


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1 ‘‘(I) IN GENERAL.—The Sec2 retary shall establish an upward pre3 ventive service payment modifier for 

4 qualifying colorectal cancer screening 

5 tests furnished on or after January 1, 

6 2010, which reflects the annual deter7 mination by the Secretary of the ap8 propriate amount of additional pay9 ment (not less than 10 percent of the 

10 amount of payment otherwise pro11 vided) sufficient to increase the rate 

12 of colorectal cancer screening tests 

13 furnished under this part to the goal 

14 rates determined under clause (i). The 

15 Secretary shall update such modifier 

16 on an annual basis, taking into con17 sideration the rate of colorectal cancer 

18 screening tests furnished under this 

19 part during the preceding year and 

20 such goal rates. 

21 ‘‘(II) QUALIFYING COLORECTAL

22 CANCER SCREENING TESTS.—For 

23 purposes of subclause (I), the term 

24 ‘qualifying colorectal cancer screening 

25 tests’ means a colorectal cancer 


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1 screening test furnished by a hospital 

2 in an outpatient setting which meets 

3 the national minimum standards es4 tablished under subparagraph (A) (as 

5 determined by the Secretary).’’. 

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

7 this section shall apply to items and services furnished on 

8 or after January 1, 2010. 

9 SEC. 7. COVERAGE FOR AN OFFICE VISIT OR CONSULTA10 TION PRIOR TO A QUALIFYING SCREENING 

11 COLONOSCOPY. 

12 (a) COVERAGE.—Section 1861(s)(2) of the Social Se13 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

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

15 the end; 

16 (2) in subparagraph (EE), by inserting ‘‘and’’ 

17 at the end; and 

18 (3) by adding at the end the following new sub19 paragraph: 

20 ‘‘(FF) an outpatient office visit or con21 sultation for the purpose of beneficiary edu22 cation, assuring selection of the proper screen23 ing test, and securing information relating to 

24 the procedure and sedation of the beneficiary, 

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1 sisting of a screening colonoscopy or in conjunc2 tion with the beneficiary’s decision to obtain 

3 such a screening, regardless of whether such 

4 screening is medically indicated with respect to 

5 the beneficiary;’’. 

6 (b) PAYMENT.— 

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

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

9 amended by section 4, is amended— 

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

11 (B) by inserting before the semicolon at 

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

13 to an outpatient office visit or consultation 

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

15 paid shall be 80 percent of the lesser of the ac16 tual charge or the amount established under 

17 section 1848’’. 

18 (2) PAYMENT UNDER PHYSICIAN FEE SCHED19 ULE.—Section 1848(j)(3) of the Social Security Act 

20 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

21 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’. 

22 (3) REQUIREMENT FOR ESTABLISHMENT OF

23 PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED24 ULE.—Section 1834(d) of the Social Security Act 

25 (42 U.S.C. 1395m(d)), as amended by section 6, is 


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1 amended by adding at the end the following new 

2 paragraph: 

3 ‘‘(5) PAYMENT FOR OUTPATIENT OFFICE VISIT

4 OR CONSULTATION PRIOR TO SCREENING

5 COLONOSCOPY.—With respect to an outpatient office 

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

7 payment under section 1848 shall be consistent with 

8 the payment amounts for CPT codes 99203 and 

9 99243.’’. 

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

11 this section shall apply to items and services furnished on 

12 or after January 1, 2010. 

Æ 


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