I 
109TH CONGRESS 
1ST SESSION H. R. 1632
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 14, 2005
Mr. ENGLISH of Pennsylvania (for himself, Mr. CARDIN, Ms. HART, Mr. WIL-
SON of South Carolina, Mr. TOWNS, Mr. SESSIONS, Mr. PICKERING, Mr. 
PETERSON of Minnesota, Mr. CLYBURN, Mr. MCNULTY, Mr. ISRAEL, and 
Mr. CUMMINGS) 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Colon Cancer Screen 
for Life Act of 2005’’.
SEC. 2. SENSE OF CONGRESS. 
It is the sense of Congress that—
(1) colorectal cancer screening tests (as defined 
in section 1861(pp)(1) of the Social Security Act (42 
U.S.C. 1395x(pp)(1)) covered under the medicare 
program have been severely underutilized, with the 
Comptroller General of the United States reporting 
in 2000 that since coverage of such tests was imple-
mented, the percentage of beneficiaries under the 
medicare program receiving either a screening or a 
diagnostic colonoscopy has increased by only 1 per-
cent; 
(2) in recognition of the need to improve rates 
of colorectal cancer screening in the medicare pro-
gram, Congress enacted provisions in the Medicare 
Prescription Drug, Improvement, and Modernization 
Act of 2003 to require physicians to provide a refer-
ral for colorectal cancer screening as part of the new 
initial preventive physical examination, beginning 
January 1, 2005; 
(3) the Centers for Medicare & Medicaid Serv-
ices should encourage health care providers to use 
more effective screening and diagnostic health care 
technologies in the area of colorectal cancer screen-
ing;
(4) in recent years, the Centers for Medicare & 
Medicaid Services has subjected colorectal cancer 
screening tests to some of the largest reimbursement 
reductions under the medicare program; 
(5) unlike other preventive screening tests cov-
ered under the medicare program, health care pro-
viders must consult with beneficiaries prior to fur-
nishing a screening colonoscopy in order to—
(A) ascertain the medical and family his-
tory of the beneficiary; and 
(B) inform the beneficiary of preparatory 
steps that must be taken prior to the procedure; 
and 
(6) reimbursement under the medicare program 
is not currently available for the consultations de-
scribed in paragraph (5) despite the fact that reim-
bursement is provided under such program for simi-
lar consultations prior to a diagnostic colonoscopy. 
SEC. 3. INCREASE IN PART B REIMBURSEMENT FOR 
COLORECTAL CANCER SCREENING AND DI-
AGNOSTIC TESTS. 
(a) IN GENERAL.—Section 1834(d) of the Social Se-
curity Act (42 U.S.C. 1395m(d)) is amended by adding 
at the end the following new paragraph:
‘‘(4) ENHANCED
PART
B
PAYMENT
FOR 
COLORECTAL CANCER SCREENING AND DIAGNOSTIC 
TESTS.—
‘‘(A) 
NONFACILITY
RATES.—Notwith-
standing paragraphs (2)(A) and (3)(A), the 
Secretary shall establish national minimum pay-
ment amounts for CPT codes 45378, 45380, 
and 45385, and HCPCS codes G0105 and 
GO121 for items and services furnished on or 
after January 1, 2006, which reflect a 10-per-
cent increase above the relative value units in 
effect as the nonfacility rates for such codes on 
December 31, 2005, with such revised payment 
level to apply to items and services performed 
in a nonfacility setting. 
‘‘(B) FACILITY
RATES.—Notwithstanding 
paragraphs (2)(A) and (3)(A), the Secretary 
shall establish national minimum payment 
amounts for CPT codes 45378, 45380, and 
45385, and HCPCS codes G0105 and GO121 
for items and services furnished on or after 
January 1, 2006, which reflect a 30-percent in-
crease above the relative value units in effect as 
the facility rates for such codes on December 
31, 2005, with such revised payment level to
apply to items and services performed in a facil-
ity setting. 
‘‘(C) ANNUAL ADJUSTMENTS.—In the case 
of items and services furnished on or after Jan-
uary 1, 2006, the payment rates described in 
subparagraphs (A) and (B) shall, subject to the 
minimum payment amounts established in such 
subparagraphs, be adjusted annually as pro-
vided in section 1848.’’. 
(b) NO EFFECT ON HOPD PAYMENTS.—The Sec-
retary of Health and Human Services shall not take into 
account the provisions of section 1834(d)(4) of the Social 
Security Act, as added by subsection (a), in determining 
the amount of payment for any covered OPD service under 
the prospective payment system for hospitals outpatient 
department services under section 1833(t) of such Act (42 
U.S.C. 1395l(t)). 
SEC. 4. MEDICARE COVERAGE OF OFFICE VISIT OR CON-
SULTATION 
PRIOR 
TO 
A 
SCREENING 
COLONOSCOPY OR IN CONJUNCTION WITH A 
BENEFICIARY’S DECISION TO OBTAIN SUCH A 
SCREENING. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) in subparagraph (Y), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (Z), by inserting ‘‘and’’ at 
the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(AA) an outpatient office visit or con-
sultation for the purpose of beneficiary edu-
cation, assuring selection of the proper screen-
ing test, and securing information relating to 
the procedure and sedation of the beneficiary, 
prior to a colorectal cancer screening test con-
sisting of a screening colonoscopy or in conjunc-
tion with the beneficiary’s decision to obtain 
such a screening, regardless of whether such 
screening is medically indicated with respect to 
the beneficiary;’’. 
(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 ‘‘(V)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (W) with respect 
to an outpatient office visit or consultation
under section 1861(s)(2)(AA), 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)(AA),’’ after ’’(2)(W),’’. 
(3) REQUIREMENT
FOR
ESTABLISHMENT
OF 
PAYMENT AMOUNT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1834(d) of the Social Security Act 
(42 U.S.C. 1395m(d)), as amended by section 3, is 
amended by adding at the end the following new 
paragraph: 
‘‘(5) 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)(AA), 
payment under section 1848 shall be consistent with 
the payment amounts for CPT codes 99203 and 
99243.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services provided on 
or after January 1, 2006.
SEC. 5. WAIVER OF DEDUCTIBLE FOR COLORECTAL CAN-
CER SCREENING TESTS. 
(a) IN GENERAL.—The first sentence of section 
1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) 
is amended—
(1) by striking ‘‘and’’ before ‘‘(6)’’; and 
(2) by inserting before the period at the end the 
following: ‘‘, and (7) such deductible shall not apply 
with respect to colorectal cancer screening tests (as 
described in section 1861(pp)(1))’’. 
(b) 
CONFORMING
AMENDMENTS.—Paragraphs 
(2)(C)(ii) and (3)(C)(ii) of section 1834(d) of the Social 
Security Act (42 U.S.C. 1395m(d)) are each amended—
(1) by striking ‘‘DEDUCTIBLE
AND’’ in the 
heading; and 
(2) in subclause (I), by striking ‘‘deductible or’’ 
each place it appears. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2006.
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