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C3: Colorectal Cancer Coalition fully endorses The Colon Cancer Screen for Life Act. Passage of this legislation is necessary to restore reimbursement for colorectal cancer screening and diagnostic tests closer to the level established in 1997 when the screening benefit was enacted.
Colorectal cancer is the third most commonly diagnosed cancer and the second most common cause of cancer death in the United States. In 2008, an estimated 148,810 new cases will be diagnosed and nearly 50,000 deaths will be caused by colorectal cancer[1].
When colorectal cancer is diagnosed at an early stage, the 5 year survival rate is nearly 90 percent. However, when cancer is not diagnosed until it has spread to distant organs, the five year survival rate is only five percent. Furthermore, the disease can even be prevented through the early identification and removal of pre-cancerous polyps, detectable only through colorectal cancer screenings.
Routine screening for colorectal cancer is critical for Medicare’s consumers. More than ninety percent of colorectal cancer occurs after the age of 50, and the risk of developing colorectal cancer increases with each decade of life.
Prior to the Balanced Budget Act (BBA) of 1997, Medicare prohibited coverage for routine colorectal cancer screening. Medicare could cover tests for colorectal cancer only when done to investigate symptoms or to monitor an individual with a history of colorectal cancer.
Through the BBA, Congress authorized coverage for routine colorectal cancer screening for Medicare recipients.
How the Balanced Budget Amendment affected the use of colonoscopies
| Period | Years | Coverage |
| 1 | 1992 – 1997 | No Screening Coverage |
| 2 | 1998 – June 2001 | Limited Screening Coverage |
| 3 | July 2001 – December 2002 | Universal Screening Coverage |
Colonoscopy use increased over each of the three time periods. The average number of colonoscopies per 100,000 people per quarter increased from 285 in period 1 to 1,919 in period 3[2].
The Colon Cancer Screen for Life Act amends title XVIII of the Social Security Act (SSA) to increase Medicare part B (Supplementary Medical Insurance) reimbursement for colorectal cancer screening and diagnostic tests:
The Act amends title XVIII of the SSA to cover one outpatient office visit or consultation for the purpose of beneficiary education before a colorectal cancer screening test consisting of a colonoscopy, or in conjunction with the beneficiary’s decision to undergo routine screening:
- Currently, Medicare covers a pre-colonoscopy visit for diagnostic colonoscopies; however, such visits are not covered for screening colonoscopies
- Screening colonoscopies – Patients without symptoms of colorectal cancer undergo screening colonoscopies.
- Diagnostic colonoscopies – Patients with symptoms of colorectal cancer or other gastro-intestinal disease may undergo diagnostic colonoscopies to identify the specific cause of the symptoms.
The bill also includes a waiver of deductible for colorectal cancer screenings: The Colon Cancer Screen for Life Act would clarify that colorectal cancer screening procedures are exempt from the customary Medicare deductible requirement regardless of the outcome of the screening.
Conclusion:
C3: Colorectal Cancer Coalition fully endorses The Colon Cancer Screen for Life Act. Passage of this legislation will increase colonoscopies among Medicare beneficiaries by eliminating unnecessary out of pocket expenses.
When Medicare began reimbursing for colonoscopies, the rate of routine screening increased substantially. In turn, the increase in screening resulted in a decrease in the number of late-stage cancers diagnosed and treated in the senior population.
Passage of The Colon Cancer Screen for Life Act decreases barriers to screening by allowing one outpatient screening colonoscopy consultation. These consultations are already reimbursed for diagnostic colonoscopies.
C3: Colorectal Cancer Coalition is a national, nonpartisan advocacy organization whose mission is to win the fight against colorectal cancer through research, empowerment and access.
[1] 2008 American Cancer Society’s Cancer Facts and Figures
[2] Journal of the American Medical Association, December 20, 2006
