Page:United States Statutes at Large Volume 101 Part 2.djvu/881

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-87

"(III) in the case of any other prevailing charge, a percent determined on the basis of a straight-line sliding scale, equal to % 3 of a percentage point for each percent by which the prevailing charge exceeds 85 percent of such weighted national average. "(iii) In no case shall the reduction under clause (i) for a procedure result in a prevailing charge in a locality for 1988 which is less than 85 percent of the Secretary's estimate of the weighted national average of such prevailing charges for such procedure for all localities in the United States for 1987 0)ased upon the best available data and determined without regard to physician specialty) after making the reduction described in clause (i)(II). "(B) The procedures described in this subparagraph are as follows: bronchoscopy,^^ carpal tunnel repair, cataract surgery, coronary artery bypass surgery, diagnostic and/or therapeutic dilation and curettage, knee arthroscopy, knee arthroplasty, pacemaker implantation surgery, total hip replacement, suprapubic prostatectomy, transurethral resection of the prostate, and upper gastrointestinal endoscopy. "(C) In the case of a reduction in the reasonable charge ifor a physicians' service under subparagraph (A), if a nonparticipating physician furnishes the service to an individual entitled to benefits under this part, after the effective date of such reduction, the physician's actual charge is subject to a limit under subsection OXIXD). "(D) There shall be no administrative or judicial review section 1869 or otherwise of any determination under subparagraph (A) or under "»> paragraph (llXBXii).". (h) MODIFICATION OF GEOGRAPHIC INDEX.—Section 1845(e)(4)(A)(i)

of such Act (42 U.S.C. 1395w-l(e)(4)(A)(i)) is amended by inserting "and costs of living" after "costs of practice". (C) CONSOUDATED CHARGE LIMITATION PROVISIONS.— (1) PENALTIES FOR EXCESS CHARGES.—Section 1842

of such Act

is further amended— (A) in subsection (b)(llXC)— ,; (i) in clause (i), by striking "(subject to clause (iv))" and all that follows through the end and inserting the following: ", the physician's actual charge is subject to a limit under subsection (j)(l)(D)."; (ii) in clause (i), by striking "(i)" after "(C)"; and (iii) by striking clauses (ii) through (iv); and (B) in subsection (j)(D, by adding at the end the following new subparagraph: "(D)(i) If an action described in clause (ii) results in a reduction in a reasonable charge for a physicians' service or item and a nonparticipating physician furnishes the service or item to an individual entitled to benefits under this part after the effective date of such action, the physician may not charge the individual more than 125 percent of the reduced payment allowance (as defined in clause (iii)) plus (for services or items furnished during the 12-month period (or 9-month period in the case of an action described in clause (iiXID) beginning on the effective date of the action) Vz of the amount by which the physician's maximum allowable actual charge for the service or item for the previous 12-month period exceeds such 125 percent level. "(ii) The first sentence of clause (i) shall apply to— ' Copy read "bronschoscopy,". ' Copy read "under under'.

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