I 
108TH CONGRESS 
1ST SESSION H. R. 1422
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 
MARCH 25, 2003
Mr. CARDIN (for himself, Mr. ENGLISH, Mr. RANGEL, Mr. PORTMAN, Mr. 
LEWIS of Georgia, Ms. DUNN, Mr. TOWNS, Mrs. JONES of Ohio, Mr. 
WILSON of South Carolina, Mr. GONZALEZ, Mr. STRICKLAND, and Ms. 
LORETTA SANCHEZ of California) 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 de-
termined 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 2003’’.
SEC. 2. SENSE OF CONGRESS. 
It is the sense of Congress that—
(1) colorectal cancer screening tests (as defined 
in section 1861(pp) of the Social Security Act (42 
U.S.C. 1395x(pp)) covered under the medicare pro-
gram 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) 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; 
(3) 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; 
(4) 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 
(5) reimbursement under the medicare program 
is not currently available for the consultations de-
scribed in paragraph (4) despite the fact that reim-
bursement is provided under such program for simi-
lar consultations prior to a diagnostic colonoscopy. 
SEC. 3. INCREASE IN REIMBURSEMENT FOR COLORECTAL 
CANCER 
SCREENING 
AND 
DIAGNOSTIC 
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
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 45330, 45378, 
45380, 45385 and HCPCS codes GO104, 
GO105, GO106, GO107, GO120, and GO121 
for items and services furnished during the last
6 months of 2003 and in subsequent years 
which reflect a 10 percent increase above the 
relative value units in effect as the nonfacility 
rates for such codes on June 30, 2003, with 
such revised payment level to apply to items 
and services performed in a nonfacility setting, 
provided, however, that such setting is con-
sistent with quality care, sound medical judg-
ment, and prevention of potential complications. 
‘‘(B) FACILITY
RATES.—Notwithstanding 
paragraphs (2)(A) and (3)(A), the Secretary 
shall establish national minimum payment 
amounts for CPT codes 45330, 45378, 45380, 
45385 and HCPCS codes GO104, GO105, 
GO106, GO107, GO120, and GO121 for items 
and services furnished during the last 6 months 
of 2003 and in subsequent years which reflect 
a 30 percent increase above the relative value 
units in effect as the facility rates for such 
codes on June 30, 2003, with such revised pay-
ment level to apply to items and services per-
formed in a facility setting. 
‘‘(C) ANNUAL ADJUSTMENTS.—In the case 
of items and services furnished on or after Jan-
uary 1, 2004, 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) EFFECTIVE DATE.—The amendment made by 
this section shall apply to items and services furnished on 
or after July 1, 2003. 
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 (U), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (V), by inserting ‘‘and’’ at 
the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(W) an outpatient office visit or consultation 
for the purpose of beneficiary education, assuring se-
lection of the proper screening test, and securing in-
formation relating to the procedure and sedation of 
the beneficiary, prior to a colorectal cancer screening
test consisting of a screening colonoscopy or in con-
junction with the beneficiary’s decision to obtain 
such a screening, regardless of whether such screen-
ing is medically indicated with respect to the bene-
ficiary;’’. 
(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 ‘‘(U)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (V) with respect 
to an outpatient office visit or consultation 
under section 1861(s)(2)(W), the amounts paid 
shall be 80 percent of the lesser of the actual 
charge or the amount established under section 
1848, except that no payment shall be made for 
such a visit or consultation if no payment would 
be made for a colorectal cancer screening test 
consisting of a screening colonoscopy for the in-
dividual furnished on the date of such visit or 
consultation because of the frequency limits de-
scribed in section 1834(d)(3)(E)’’. 
(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)(W),’’ after ‘‘(2)(S),’’. 
(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)(W), 
payment under section 1848 shall be consistent with 
the payment amounts for CPT codes 99203 and 
99243.’’. 
(4) 
FREQUENCY
LIMITATION.—Section 
1862(a)(1) of the Social Security Act (42 U.S.C. 
1395y(a)(1)) is amended—
(A) in subparagraph (H), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (I), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by inserting after subparagraph (I) the 
following new subparagraph:
‘‘(J) in the case of an outpatient office visit or 
consultation under section 1861(s)(2)(W), which is 
performed more frequently that is covered under sec-
tion 1833(a)(1)(V);’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services provided on 
or after July 1, 2003. 
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 amendment made by 
this section shall apply to items and services furnished on 
or after July 1, 2003.
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