RADIOLOGY SERVICES.

SEC. 4102. RADIOLOGY SERVICES. (a) Reduction in Fee Schedule.—Section 1834(b)(4) (42 U.S.C. 1395m(b)(4)) is amended— (1) by redesignating subparagraphs (D) and (E) as subparagraphs (E) and (F), respectively, and (2) by inserting after subparagraph (C) the following new subparagraph: “(D) 1991 fee schedules.— For radiologist services (other than portable x-ray services) furnished under this part during 1991, the conversion factors used in a locality under this subsection shall be determined as follows: “(i) National weighted average conversion factor.—The Secretary shall estimate the national weighted average of the conversion factors used under this subsection for services furnished during 1990 beginning on April 1, using the best available data. “(ii) Reduced national weighted average.—The national weighted average estimated under clause (i) shall be reduced by 13 percent. 104 STAT. 1388–56 “(iii) Computation of 1990 locality index relative to national average.—The Secretary shall establish an index which reflects, for each locality, the ratio of the conversion factor used in the locality under this subsection to the national weighted average estimated under clause (i). “(iv) Local adjustment.—Subject to clause (vii), the conversion factor to be applied to the professional or technical component of a service in a locality is the sum of ½ of the locally-adjusted amount determined under clause (v) and ½ of the GPCI-adjusted amount determined under clauses (vi). “(v) Locally-adjusted amount.—For purposes of clause (iv), the locally adjusted amount determined under this clause is the product of (I) the national weighted average conversion factor computed under clause (ii), and (ID the index value established under clause (iii) for the locality. “(vi) GPCI adjusted amount.— For purposes of clause (iv), the GPCI-adjusted amount determined under this clause is the sum of— “(I) the product of (a) the portion of the reduced national weighted average conversion factor computed under clause (ii) which is attributable to physician work and (b) the geographic work index value for the locality (specified in Addendum C to the Model Fee Schedule for Physician Services (published on September 4, 1990, 55 Federal Register pp. 36238–36243)); and “(II) the product of (a) the remaining portion of the reduced national weighted average conversion factor computed under clause (ii), and (b) the geographic practice cost index value specified in section 1842(b)(14)(C)(iv) for the locality. In applying this clause with respect to the professional component of a service, 80 percent of the conversion factor shall be considered to be attributable to physician work and with respect to the technical component of the service, 0 percent shall be considered to be attributable to physician work. “(vii) Limits on conversion factor.—The conversion factor to be applied to a locality under this subparagraph to the professional or technical component of a service shall not be more than 9.5 percent below the conversion factor applied in the locality under subparagraph (C) to such component, but in no case shall the conversion factor be less than 60 percent of the national weighted average of the conversion factors (computed under clause (i)).”. (b) Special Rule for Transition for Radiology Services.—Section 1848(a)(2)(C) (42 U.S.C. 1395w–4(a)(2)(C)) is amended— (1) by inserting “and radiology” after “Special rule for anesthesia”, and (2) by adding at the end the following: “With respect to radiology services, T09 percent’ and ‘9 percent’ shall be substituted for ‘115 percent’ and T5 percent‘, respectively, in subparagraph (A)(ii). 104 STAT. 1388–57 (c) Reduction in Prevailing Charge Level for Other Radiology Services.— (1) In general.—In applying part B of title XVIII of the Social Security Act, the prevailing charge for physicians’ services, furnished during 1991, which are radiology services may not exceed the fee schedule amount established under section 1834(b) of such Act with respect to such services. (2) Exception.—Paragraph (1) shall not apply to radiology services which are subject to section 6105(b) of the Omnibus Budget Reconciliation Act of 1989. (d) Reduction in Payments for Technical Components of Certain Scanning Services.—Section 1834(b)(4) (42 U.S.C. 1395m(b)(4)) is amended by inserting after subparagraph (D) the following new paragraph: “(E) In the case of the technical components of magnetic resonance imaging (MRI) services and computer assisted tomography (CAT) services furnished after December 31, 1990, the amount otherwise payable shall be reduced by 10 percent.”. (e) Limitation on Adjustments.—For radiologist services furnished during 1991 for which payment is made under section 1834(b) of the Social Security Act— (1) a carrier may not make any adjustment, under section 1842(b)(3)(B) of such Act, in the payment amount for the service under section 1834(b) on the basis that the payment amount is higher than the charge applicable, for a comparable service and under comparable circumstances, to the policyholders and subscribers of the carrier, (2) no payment adjustment may be made under section 1842(b)(8) of such Act, and (3) section 1842(b)(9) of such Act shall not apply. (f) Use of Localities.—Section 1834(b)(l)(B) (42 U.S.C. 1395m(b)(l)(B)) is amended by inserting “locality,” after “state-wide,”. (g) Treatment of Nuclear Medicine Physicians.— (1) Continuation of special rule.—Section 6105(b) of the Omnibus Budget Reconciliation Act of 1989 is amended by striking all that follows “Social Security Act” the second place it appears and inserting the following: “beginning April 1, 1990, and ending December 31, 1991, there shall be substituted for the fee schedule otherwise applicable a fee schedule based ⅓ on the fee schedule computed under such section (without regard to this subsection) and ⅔ on 101 percent of the 1988 prevailing charge for such services.”. (2) Adjusted historical payment basis.— Section 1848(a)(2)(D) (42 U.S.C. 1395w-4(a)(2)(D)) is amended— (A) in clause (ii) by inserting “, but excluding nuclear medicine services that are subject to section 6105(b) of the Omnibus Budget Reconciliation Act of 1989” after “section 1834(b)(6))”, and (B) by adding at the end the following: “(iii) Nuclear medicine services.—In applying clause (i) in the case of physicians’ services which are nuclear medicine services that are subject to section 6105(b) of the Omnibus Budget Reconciliation Act of 1989, there shall be substituted for the weighted aver-104 STAT. 1388–58age prevailing charge the amount provided under such section.”. (h) Extension of Split Billing Rule for Interventional Radiologists.—Section 6105(c) of the Omnibus Budget Reconciliation Act of 1989 is amended by inserting “or 1991” after “1990” each place it appears. (i) Effective Dates.— (1) Except as otherwise provided, the amendments made by this section shall apply to services furnished on or after January 1, 1991. (2) The amendment made by subsection (f) shall be effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987.