MISCELLANEOUS PROVISIONS RELATING TO PAYMENT FOR PHYSICIANS’ SERVICES.

SEC. 6108. MISCELLANEOUS PROVISIONS RELATING TO PAYMENT FOR PHYSICIANS’ SERVICES. (a) Customary Charge for New Physicians.— (1) Phase-in to prevailing charge level.— Section 1842(b)(4)(F) of the Social Security Act (42 U.S.C. 1395u(b)(4)(F)) is amended— (A) by inserting “furnished during a calendar year” after “physicians’ services”, and (B) by adding at the end the following: “For the first calendar year during which the preceding sentence no longer applies, the Secretary shall set the customary charge at a level no higher than 85 percent of the prevailing charge for the service.”. (2) Effective date.—(A) Subject to subparagraph (B), the amendments made by paragraph (1) apply to services furnished in 1990 which were subject to the first sentence of section 1842(b)(4)(F) of the Social Security Act in 1989. (B) The amendments made by paragraph (1) shall not apply to services furnished in 1990 before April 1, 1990. With respect to physicians’ services furnished during 1990 on and after April 1, such amendments shall be applied as though any reference, in the matter inserted by such amendments, to the “first calendar year during which the preceding sentence no longer applies” were deemed a reference to the remainder of 1990. (b) Limitation on Amounts for Certain Services Furnished by More Than One Specialty.— (1) In general.—Section 1842(b) of such Act (42 U.S.C. 1395u(b)), as amended by section 6104(a) of this subtitle, is amended by adding at the end the following: “(15)(A) In determining the reasonable charge for surgery, radiology, and diagnostic physicians’ services which the Secretary shall designate (based on their high volume of expenditures under this part) and for which the prevailing charge (but for this paragraph) differs by physician specialty, the prevailing charge for such a service may not exceed the prevailing charge or fee schedule amount for that specialty of physicians that furnish the service most frequently nationally. “(B) In the case of a reduction in the prevailing charge for a physician’s service under subparagraph (A), if a nonparticipating physician furnishes the service to an individual entitled to benefits 103 STAT. 2213under this part, after the effective date of the reduction, the physician’s actual charge is subject to a limit under subsection (j)(1)(D).”. (2) Special limits on actual charges.— Section 1842(j)(1)(D) of such Act (42 U.S.C. 1395u(j)(1)(D)) is amended— (A) in clause (ii)(IV), by inserting “or (b)(15)(A)” before the comma at the end, and (B) in clause (iii)(II), by striking “or (b)(14)(A)” and inserting “(b)(14)(A), or(b)(15)(A)”. (3) Effective date.—The amendments made by this subsection apply to procedures performed after March 31, 1990.