ASSISTANTS AT SURGERY.

SEC. 4107. ASSISTANTS AT SURGERY. (a) Physicians as Assistants-At-Surgery.— (1) In general.—Section 1848(i) (42 U.S.C. 1395w-4(i)) is amended by adding at the end the following: “(2) Assistants-at-surgery.— “(A) In general.—Subject to subparagraph (B), in the case of a surgical service furnished by a physician, if payment is made separately under this part for the services of a physician serving as an assistant-at-surgery, the fee schedule amount shall not exceed 16 percent of the fee schedule amount otherwise determined under this section for the global surgical service involved. “(B) Denial of payment in certain cases.—If the Secretary determines, based on the most recent data available, that for a surgical procedure (or class of surgical procedures) the national average percentage of such procedure performed under this part which involve the use of a physician as an assistant at surgery is less than 5 percent, no payment may be made under this part for services of an assistant at surgery involved in the procedure.”. (2) Application in 1991—Section 1848(i)(2) of the Social Security Act, as added by the amendment made by paragraph (1), shall apply to services furnished in 1991 in the same manner as it applies to services furnished after 1991. In applying the previous sentence, the prevailing charge shall be substituted for the fee schedule amount. (b) Conforming Amendment.—Section 1862(a)(15) of such Act (42 U.S.C. 1395y(a)(15)) is amended— (1) by inserting “(A)” after “(15)”, 104 STAT. 1388–63 (2) by striking “; or” at the end and inserting “, or”, and (3) by adding at the end the following new subparagraph: “(B) which are for services of an assistant at surgery to which section 1848(i)(2)(B) applies; or”. (c) Effective Date.—The amendment made by subsection shall apply with respect to services furnished on or after January 1, 1992.