SEC. 
4. 
WAIVING 
MEDICARE 
COST-SHARING 
FOR 
COLORECTAL 
CANCER 
SCREENING 
WITH 
THERAPEUTIC EFFECT. 
(a) IN GENERAL.—Section 1833(a)(1)(Y) of the So-
cial Security Act (42 U.S.C. 1395l(a)(1)(Y)) is amended 
by inserting ‘‘, including tests and procedures described 
in the last sentence of subsection (b),’’ after ‘‘section 
1861(ddd)(3)’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to tests and procedures performed 
on or after January 1, 2013. 
SEC. 5. MEDICARE COVERAGE FOR AN OFFICE VISIT OR 
CONSULTATION PRIOR TO A QUALIFYING 
SCREENING COLONOSCOPY. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (EE), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (FF), by inserting ‘‘and’’ 
at the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(GG) prior to a colorectal cancer screening 
test consisting of a screening colonoscopy or in con-
junction with an individual’s decision regarding the 
performance of such a test on the individual, an out-
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patient office visit or consultation for the purpose of 
beneficiary education, assuring selection of the prop-
er screening test, and securing information relating 
to the procedure and the sedation of the indi-
vidual;’’. 
(b) PAYMENT.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and’’ before ‘‘(Z)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (AA) with respect 
to an outpatient office visit or consultation 
under section 1861(s)(2)(GG), the amounts 
paid shall be 80 percent of the lesser of the ac-
tual charge or the amount established under 
section 1848’’. 
(2) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(GG),’’ after ‘‘(2)(FF) (including administration 
of the health risk assessment),’’. 
(3) REQUIREMENT
FOR
ESTABLISHMENT
OF 
PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1834(d) of the Social Security Act 
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(42 U.S.C. 1395m(d)) is amended by adding at the 
end the following new paragraph: 
‘‘(4) PAYMENT FOR OUTPATIENT OFFICE VISIT 
OR
CONSULTATION
PRIOR
TO
SCREENING 
COLONOSCOPY.—With respect to an outpatient office 
visit or consultation under section 1861(s)(2)(GG), 
payment under section 1848 shall be consistent with 
the payment amounts for CPT codes 99201, 99202, 
99203, 99204, 99211, 99212, 99213, 99214, and 
99215 (as in effect as of the date of the enactment 
of this paragraph or any successors to such codes).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2013. 
SEC. 6. BUDGET NEUTRALITY. 
(a) ADJUSTMENT
OF PHYSICIAN FEE SCHEDULE 
CONVERSION FACTOR.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall reduce the conversion factor established 
under subsection (d) of section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) for each year (beginning with 
2013) to the extent necessary to reduce expenditures 
under such section for items and services furnished during 
the year in the aggregate by the net offset amount deter-
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mined under subsection (c)(5) attributable to such section 
for the year. 
(b) ADJUSTMENT
OF HOPD CONVERSION FAC-
TOR.—The Secretary shall reduce the conversion factor es-
tablished under paragraph (3)(C) of section 1833(t) of the 
Social Security Act (42 U.S.C. 1395l(t)) for each year (be-
ginning with 2013) to the extent necessary to reduce ex-
penditures under such section for items and services fur-
nished during the year in the aggregate by the net offset 
amount determined under subsection (c)(5) attributable to 
such section for the year. 
(c) DETERMINATIONS
RELATING
TO
EXPENDI-
TURES.—For purposes of this section, before the begin-
ning of each year (beginning with 2013) at the time con-
version factors described in subsection (a) and (b) are es-
tablished for the year, the Secretary shall determine— 
(1) the amount of the gross additional expendi-
tures under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) estimated to result from 
the implementation of sections 3, 4, and 5 for items 
and services furnished during the year; 
(2) the amount of any offsetting reductions in 
expenditures under such title (such as reductions in 
payments for inpatient hospital services) for such 
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year attributable to the implementation of such sec-
tions; 
(3) the amount (if any) by which the amount 
of the gross additional expenditures determined 
under paragraph (1) for the year exceeds the 
amount of offsetting reductions determined under 
paragraph (2) for the year; 
(4) of the gross additional expenditures deter-
mined under paragraph (1) for the year that are at-
tributable to expenditures under sections 1848 and 
1833(t) of such Act, the ratio of such expenditures 
that are attributable to each respective section; and 
(5) with respect to section 1848 and section 
1833(t) of such Act, a net offset amount for the 
year equal to the product of— 
(A) the amount of the net additional ex-
penditures for the year determined under para-
graph (3); and 
(B) the ratio determined under paragraph 
(4) attributable to the respective section. 
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