HR 6886 RFS 
‘‘(jjj) PROSTATE CANCER DNA SPECIMENT PROVE-
NANCE ASSAY TEST.—The term ‘prostate cancer DNA 
Specimen Provenance Assay Test’ (DSPA test) means a 
test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, as-
sesses the identity of the DNA in such specimens by com-
paring such DNA with the DNA that was separately taken 
from such individual at the time of the biopsy.’’. 
(2) EXCLUSION
FROM
COVERAGE.—Section 
1862(a)(1) of the Social Security Act (42 U.S.C. 
1395y(a)(1)) is amended— 
(A) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (P), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) in the case of a prostate cancer DNA 
Specimen Provenance Assay test (DSPA test) (as 
defined in section 1861(jjj)), unless such test is fur-
nished on or after January 1, 2020, and before Jan-
uary 1, 2025, and such test is ordered by the physi-
cian who furnished the prostate cancer biopsy that 
obtained the specimen tested;’’. 
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(b) PAYMENT AMOUNT
AND RELATED REQUIRE-
MENTS.—Section 1834 of the Social Security Act (42 
U.S.C. 1395m) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(w) PROSTATE CANCER DNA SPECIMEN PROVE-
NANCE ASSAY TESTS.— 
‘‘(1) PAYMENT FOR COVERED TESTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the payment amount for a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(jjj)) 
shall be $200. Such payment shall be payment 
for all of the specimens obtained from the bi-
opsy furnished to an individual that are tested. 
‘‘(B) LIMITATION.—Payment for a DSPA 
test under subparagraph (A) may only be made 
on an assignment-related basis. 
‘‘(C) PROHIBITION
ON
SEPARATE
PAY-
MENT.—No separate payment shall be made for 
obtaining DNA that was separately taken from 
an individual at the time of a biopsy described 
in subparagraph (A). 
‘‘(2) HCPCS CODE
AND
MODIFIER
ASSIGN-
MENT.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
assign one or more HCPCS codes to a prostate 
cancer DNA Specimen Provenance Assay test 
and may use a modifier to facilitate making 
payment under this section for such test. 
‘‘(B) IDENTIFICATION OF DNA MATCH ON 
CLAIM.—The Secretary shall require an indica-
tion on a claim for a prostate cancer DNA 
Specimen Provenance Assay test of whether the 
DNA of the prostate biopsy specimens match 
the DNA of the individual diagnosed with pros-
tate cancer. Such indication may be made 
through use of a HCPCS code, a modifier, or 
other means, as determined appropriate by the 
Secretary. 
‘‘(3) DNA MATCH REVIEW.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
review at least three years of claims under part 
B for prostate cancer DNA Specimen Prove-
nance Assay tests to identify whether the DNA 
of the prostate biopsy specimens match the 
DNA of the individuals diagnosed with prostate 
cancer. 
‘‘(B) POSTING ON INTERNET WEBSITE.— 
Not later than July 1, 2023, the Secretary shall 
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post on the Internet website of the Centers for 
Medicare & Medicaid Services the findings of 
the review conducted under subparagraph 
(A).’’. 
(c) COST-SHARING.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (CC) with respect to a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(jjj)), the 
amount paid shall be an amount equal to 80 percent 
of the lesser of the actual charge for the test or the 
amount specified under section 1834(w)’’. 
Passed the House of Representatives September 28, 
2018. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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