(WASHINGTON, D.C.) – Congressman Jamie Raskin (MD-08) joined Rep. Donald McEachin (VA-04) in urging the Centers for Medicare and Medicaid Services (CMS) to use its existing statutory authority to eliminate coinsurance costs for preventive colonoscopies for Medicare beneficiaries, even in cases when a polyp is removed. Congressmen Donald M. Payne, Jr. (D-NJ-10), Rodney Davis (R-IL-13), and David B. McKinley, P.E. (R-WV-1) joined as co-leads on the letter; these Members of Congress are also the lead sponsors of the Removing Barriers to Colorectal Cancer Screening Act of 2019, which would close the Medicare colorectal screening loophole by amending current law rather than through administration rulemaking.

“As a colorectal cancer conqueror, I know firsthand that regular colonoscopy screenings can save lives,” said Congressman A. Donald McEachin. “No one in need should forego this critical and effective screening due to financial constraints. I urge Administrator Verma to act quickly and waive the current coinsurance fee that can often lead to surprise medical bills. This is a common-sense solution that could be lifesaving for seniors throughout the country.”

“Charging beneficiaries for screenings that result in polyp removal is confusing for both providers and patients,” wrote the lawmakers. “Moreover, this policy could be limiting access to colorectal cancer screenings among Medicare beneficiaries at a time when Medicare-aged individuals account for more than half of colorectal cancer diagnoses. We urge you to use your statutory authority to remove the coinsurance requirement when screening colonoscopies become diagnostic procedures. By making this commonsense fix to Medicare, we can improve health outcomes and save money for seniors and their families.”

“We know that screenings are an effective way to lower incidence rates and deaths from colorectal cancer,” said Lisa A. Lacasse, President, American Cancer Society Cancer Action Network. “But seniors on Medicare could choose to forego these critical preventive procedures due to fear of waking up to a surprise bill when a polyp is removed. Closing this loophole in Medicare would be a significant victory for seniors in this country and all of us working to end suffering and death from cancer. We commend Representatives McEachin, Davis, Payne, McKinley for championing policies that get us closer to that goal and call on the administration to remove cost-sharing for colorectal cancer screening and help save lives.” 

“Fight Colorectal Cancer is grateful to Reps. McEachin, Davis, Payne and McKinley and the 80 other Members of Congress who support this effort to finally close the so-called “Medicare loophole," said Anjee Davis, President, Fight Colorectal Cancer. "The colorectal cancer community has been working tirelessly for nearly a decade to remove this barrier to screening and we join our congressional champions in urging the Administration to fix this glitch in Medicare statute to help increase access to lifesaving colorectal cancer screening.”


Under current law, seniors covered by Medicare are eligible for colorectal cancer screenings without cost-sharing. However, if a physician takes further preventive action during the screening colonoscopy, such as removing a polyp, the procedure is billed as “diagnostic” rather than a “preventive service,” costing seniors as much as $350 in coinsurance costs depending on the site of service.

Full letter text is available here.