I 

111TH CONGRESS 

2D SESSION H. R. 5461 

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 

MAY 28, 2010 

Mr. DAVIS of Illinois (for himself, Mr. KIRK, and Mr. BOREN) 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 ‘‘Virtual Screening for 

5 Colorectal Cancer Act of 2010’’. 


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1 SEC. 2. COVERING SCREENING COMPUTED TOMOGRAPHY 

2 COLONOGRAPHY AS A COLORECTAL CANCER 

3 SCREENING TEST UNDER MEDICARE.. 

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

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

6 (1) by redesignating subparagraph (D) as sub7 paragraph (E); and 

8 (2) by inserting after subparagraph (C) the fol9 lowing new subparagraph: 

10 ‘‘(D) Screening computed tomography 

11 colonography.’’. 

12 (b) FREQUENCY LIMITS AND PAYMENT.—Section 

13 1834(d) of such Act (42 U.S.C. 1395m(d)) is amended 

14 by adding at the end the following new paragraph: 

15 ‘‘(4) SCREENING COMPUTED TOMOGRAPHY

16 COLONOGRAPHY.— 

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

18 colorectal cancer screening test consisting of 

19 screening computed tomography colonography, 

20 subject to subparagraph (B), payment under 

21 section 1848 shall be consistent with payment 

22 under such section for similar or related serv23 ices. 

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

25 screening computed tomography colonography, 


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1 payment under this part shall not exceed such 

2 amount as the Secretary specifies. 

3 ‘‘(C) FACILITY PAYMENT LIMIT.— 

4 ‘‘(i) LIMITATION ON COINSURANCE.— 

5 Notwithstanding any other provision of 

6 this title, in the case of an individual who 

7 receives screening computed tomography 

8 colonography— 

9 ‘‘(I) in computing the amount of 

10 any applicable coinsurance, the com11 putation of such coinsurance shall be 

12 based upon the fee schedule under 

13 which payment is made for the serv14 ices; and 

15 ‘‘(II) the amount of such coinsur16 ance shall not exceed 25 percent of 

17 the payment amount under the fee 

18 schedule described in subparagraph 

19 (A). 

20 ‘‘(D) FREQUENCY LIMIT.—No payment 

21 may be made under this part for a colorectal 

22 cancer screening test consisting of a screening 

23 computed tomography colonography— 

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

25 of age; or 


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

2 high risk for colorectal cancer, if the proce3 dure is performed within the 23 months 

4 after a previous screening computed to5 mography colonography or a previous 

6 screening colonoscopy; or 

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

8 is not at high risk for colorectal cancer, if 

9 the procedure is performed within the 119 

10 months after a previous screening 

11 colonoscopy or within the 59 months after 

12 a previous screening flexible sigmoidoscopy 

13 or a previous screening computed tomog14 raphy colonography.’’. 

15 (c) CONFORMING FREQUENCY LIMITS FOR OTHER

16 COLORECTAL CANCER SCREENING TESTS.— 

17 (1) SCREENING FLEXIBLE SIGMOIDOSCOPY.— 

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

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

20 inserting ‘‘or screening computed tomography 

21 colonography’’ after ‘‘previous screening flexible 

22 sigmoidoscopy’’. 

23 (2) SCREENING COLONOSCOPY.—Paragraph 

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


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1 (A) by inserting ‘‘or screening computed 

2 tomography colonography’’ after ‘‘23 months 

3 after a previous screening colonoscopy’’; and 

4 (B) by inserting ‘‘or screening computed 

5 tomography colonography’’ after ‘‘screening 

6 flexible sigmoidoscopy’’. 

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

8 this section shall apply to items and services furnished on 

9 or after January 1, 2011. 

10 SEC. 3. EXEMPTION OF SCREENING COMPUTED TOMOG11 RAPHY COLONOGRAPHY FROM SPECIAL 

12 RULE ON PAYMENT FOR IMAGING SERVICES. 

13 (a) IN GENERAL.—Section 1848(b)(4)(B) of the So14 cial Security Act (42 U.S.C. 1395w–4(b)(4)(B)) is amend15 ed by inserting ‘‘and screening computed tomography 

16 colonography’’ after ‘‘diagnostic and screening mammog17 raphy’’. 

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

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

20 on or after January 1, 2011. 

21 SEC. 4. REPORT ON THE EFFECTIVENESS OF SCREENING 

22 CTC IN IMPROVING OVERALL CRC COMPLI23 ANCE. 

24 (a) GAO STUDY AND REPORTS ON EFFECTIVENESS

25 OF SCREENING COMPUTED TOMOGRAPHY COLONOGRAPY


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1 IN IMPROVING OVERALL COLORECTAL CANCER COMPLI2 ANCE.— 

3 (1) STUDY.— 

4 (A) IN GENERAL.—The Comptroller Gen5 eral of the United States (in this subsection re6 ferred to as the ‘‘Comptroller General’’) shall 

7 conduct a study, by colorectal cancer screening 

8 procedure type, on— 

9 (i) the effect of the addition of the 

10 screening computed tomography 

11 colonography (in this subsection referred 

12 to as ‘‘screening CTC’’) benefit under sec13 tion 1861(pp)(1)(D) of the Social Security 

14 Act, as added by section 2(a); 

15 (ii) the effect of the addition of such 

16 benefit as part of an overall set of 

17 colorectal cancer screening (in this sub18 section referred to as the ‘‘CRC screen19 ing’’) made available to relevant Medicare 

20 population, including individuals over 50 

21 years of age and over 75 years of age; and 

22 (iii) any other relevant questions in23 volving access to, beneficiary preference of, 

24 and the value of, screening CTC for Medi25 care beneficiaries. 


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1 (B) ISSUES.—The study conducted under 

2 subparagraph (A) shall examine the following: 

3 (i) The impact of screening CTC on 

4 the change in CRC screening compliance of 

5 Medicare beneficiaries. 

6 (ii) The various utilization rates for 

7 the each available CRC screening option 

8 before and after the availability of screen9 ing CTC, including— 

10 (I) by initial CRC screening per11 formed as a Medicare beneficiary, in12 cluding the beneficiary age when ini13 tial screening was performed; and 

14 (II) by follow-on screening per15 formed, whereby the analysis dem16 onstrates to what extent screening 

17 CTC was used as a substitute for a 

18 previous screening procedure. 

19 (iii) The referral rate of screening 

20 CTC to follow-on optical colonoscopy. 

21 (iv) An analysis of beneficiary pref22 erence to the various CRC screening op23 tions. 

24 (v) Access to screening CTC by Medi25 care beneficiaries, especially in rural areas 


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1 or underserved populations, before and 

2 after implementation of such screening 

3 benefit. 

4 (vi) Such other issues as the Comp5 troller General determines appropriate. 

6 (2) REPORTS.— 

7 (A) PRELIMINARY REPORT.—Not later 

8 than March 1, 2015, the Comptroller General 

9 shall submit a preliminary report to Congress 

10 on the study conducted under paragraph (1). 

11 (B) FINAL REPORT.—Not later than 

12 March 1, 2016, the Comptroller General shall 

13 submit a final report to Congress on the study 

14 conducted under paragraph (1), together with 

15 recommendations for such legislation and ad16 ministrative action as the Comptroller General 

17 determines appropriate. 

Æ 


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