Page:United States Statutes at Large Volume 101 Part 2.djvu/883

 PUBLIC LAW 100-203—DEC. 22, 1987

101 STAT. 1330-89

of the prevailing charge level established with respect to extracapsular cataract removal with lens implantation."; and (2) in subparagraph (D) of subsection (j)(D, as added by section 4045(c)(l)(B) of this subtitle— (A) in clause (ii), by striking "and" at the end of subclause (III), by redesignating subclause (IV) as subclause (V) and by inserting before such subclause the following new ,r'subclause: "(IV) a prevailing charge limit is established under subsection (b)(llXC)(i), and"; and (B) in clause (iii)(II), by striking "or (b)(llXB)" and inserting ", (b)(llXB), or (b)(ll)(C)(i)". (b) EFFECTIVE DATE.—The amendments made by subsection (a) shall apply to services furnished on or after April 1, 1988.

42 USC 1395u note.

SEC. 4047. CUSTOMARY CHARGES FOR PRIMARY CARE SERVICES OF NEW PHYSICIANS.

(a) IN GENERAL.—Section 1842(b)(4) of the Social Security Act, as amended by section 4042(a), is further amended by adding at the end thereof the following new subparagraph: "(G) In determining the customary charges for physicians' services (other primary care services and other than services furnished in a rural area (as defined in section 1886(d)(2)(D)) that is designated, under section 332(a)(1)(A) of the Public Health Service Act, as a health manpower shortage area) for which adequate actual charge data are not available because a physician has not yet been in practice for a sufficient period of time, the Secretary shall set a customary charge at a level no higher than 80 percent of the prevailing charge (as determined under the third and fourth sentences of paragraph (3) and under paragraph (4)) for a service.". 0)) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to physicians who first furnish services to medicare beneficiaries after April 1, 1988.

42 USC 1395U note.

SEC. 4048. PAYMENT FOR PHYSICIAN ANESTHESIA SERVICES.

(a) IN GENERAL.—Section 1842(b) of the Social Security Act (42 U.S.C. 1395u(b)) is further amended by adding at the end the following new paragraph: "(14)(A) In determining the reasonable charge under paragraph (3) of a physician for medical direction of two or more nurse anesthetists performing, on or after April 1, 1988, and before January 1, 1991, anesthesia services in whole or in part concurrently, the number of base units which may be recognized with respect to such medical direction for each concurrent procedure (other than cataract surgery or an iridectomy) shall be reduced by— "(i) 10 percent, in the case of medical direction of 2 nurse anesthetists concurrently, "(ii) 25 percent, in the case of medical direction of 3 nurse anesthetists concurrently, and "(iii) 40 percent, in the case of medical direction of 4 nurse anesthetists concurrently. "(B) In determining the reasonable charge under paragraph (3) of a physician for medical direction of two or more nurse anesthetists performing, on or after January 1, 1989, and before January 1, 1991, anesthesia services in whole or in part concurrently, the number of base units which may be recognized with respect to such medical

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