House Bill Would Make Colonoscopy, Polyp Removal Free for Medicare Patients
Groups want to allow removal of polyps during procedure with no unexpected co-pay
March 1, 2012 - Colonoscopy for colorectal cancer screening saves lives, but a loophole in current Medicare law may cause
patients to think twice before undergoing this vital test, says three medical groups. Legislation introduced today seeks to ensure that
colorectal cancer screening for all Medicare beneficiaries is free, as was intended.
The Patient Protection and Affordable Care Act, sometimes referred to as “Obamacare,” waives the coinsurance and
deductible for many cancer screening tests, including colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT), which screen for
Colonoscopy is a unique screening test because gastroenterologists are able to remove precancerous polyps and small
cancers during the screening procedure. Under Medicare billing rules, removal of any polyp reclassifies the screening as a therapeutic
procedure, for which patients will receive an unexpected coinsurance bill. In some cases this may be covered by other supplemental insurance.
The Removing Barriers to Colorectal Cancer Screening Act of 2012 introduced today by Rep. Charlie Dent, R-PA, waives the
coinsurance for a screening colonoscopy regardless of whether a polyp or lesion is found.
Congressman Dent represents Pennsylvania’s 15th District, which is home to a large life sciences industry that includes
research universities, national healthcare providers and biotech firms.
Last year, Rep. Dent, introduced a bill for the U.S. Postal Service to issue a stamp promoting the fight against
colorectal cancer. It was referred to a subcomittee on military personnel.
Under current Medicare policy, the beneficiary deductible is waived regardless of whether a polyp or lesion is found.
Congressman Dent's bill applies the same rational policy to beneficiary coinsurance.
The American Cancer Society Cancer Action Network (ACS CAN), the American Gastroenterological Association (AGA) and the
American Society for Gastrointestinal Endoscopy (ASGE) have been advocating for the past year and half that Congress corrects this
"cost-sharing" problem, which continues to cause confusion for patients and providers.
Cost sharing creates financial barriers, which could discourage the use of colonoscopy. The Removing Barriers to
Colorectal Cancer Screening Act of 2012 is critical to achieving higher screening rates and reducing the incidence of colorectal cancer.
Almost 38 percent of U.S. adults age 50 and older have never been screened, despite the fact that removing precancerous
polyps cuts the death rate from colorectal cancer by half.
Christopher W. Hansen, president, ACS CAN, said, "I commend Representative Dent for this important effort to ensure that
everyone has access to life saving cancer screenings, without regard to their ability pay. Too many Americans are going without lifesaving
screenings because they cannot afford it. We urge Congress to help stop a cancer that can be prevented in many cases."
on Colon Cancer Screenings (Colorectal)
How often is it covered?
Fecal Occult Blood Test: Once every 12 months.
Flexible Sigmoidoscopy: Generally, once every 48 months,
or 120 months after a previous screening colonoscopy for people not at high risk.
Screening Colonoscopy: Generally once every 120 months
(once every 24 months if you're at high risk), or 48 months after a previous flexible sigmoidoscopy.
Barium Enema: Your doctor can decide to use this test
instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for
colorectal cancer and every 48 months if you aren't at high risk.
You're at high risk if you have any
of the following risk factors:
A close relative (sibling, parent, or child) who has had colorectal
cancer or an adenomatous polyp (a type of polyp that could become cancerous)
A family history of familial adenomatous polyposis (this involves
multiple adenomatous polyps, often in the hundreds, and carries a very high risk of colon cancer)
A family history of hereditary nonpolyposis colorectal cancer (a type of
colorectal cancer that runs in families and tends to cause cancer at a relatively young age - under 45 years)
A personal history of adenomatous polyps
A personal history of colorectal cancer
A personal history of inflammatory bowel disease, including Crohn's
Disease and ulcerative colitis
All people with Medicare are eligible for a screening colonoscopy. All other
colorectal screenings are available to people with Medicare age 50 and older.
Your costs in Original Medicare
You pay nothing for the fecal occult blood test. You pay nothing for the
flexible sigmoidoscopy or screening colonoscopy, if your doctor accepts
"The rate of colorectal cancers and deaths can be decreased through the increased use of screening,” added Lawrence S.
Kim, MD, AGAF, Community Private Practice Councillor. “However, a majority of Americans are still not participating in these lifesaving tests.
“The Removing Barriers to Colorectal Cancer Screening Act of 2012 will provide consistency and security for patients
seeking colorectal cancer screenings by eliminating financial barriers and removing the confusion facing patients and their physicians over
the current health-care policy."
"Colorectal cancer is a largely preventable disease,” noted Gregory G. Ginsberg, MD, FASGE, president, American Society
for Gastrointestinal Endoscopy. The greatest benefit of colonoscopy screening is removing polyps that are discovered during screening and by
so doing, significantly decreasing the risk for later cancer development.
“Converting a screening procedure that is fully covered by insurance with no cost-sharing, to one that does require
cost-sharing by the patient after a polyp is found, is both a barrier to screening and inconsistent with the goal of the preventive services
provision,” he said.
Following are descriptions provided by the groups pushing this action.
About the American Cancer Society Cancer Action Network
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and
legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to
make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need
to make their voices heard. For more information, visit
About the American Gastroenterological Association
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown
to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology.
The AGA Institute administers the practice, research and educational programs of the organization.
http://www.gastro.org. Become an
AGA fan on Facebook. Join our
LinkedIn group. Follow us on Twitter
About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing
patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with nearly 12,000 members worldwide, promotes
the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy,
and is the foremost resource for endoscopic education. Visit
http://www.screen4coloncancer.org for more information and to find a qualified
doctor in your area.
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