42 U.S.C. 1395m: Special payment rules for particular items and services

2024

• Pub. L. 118–158, §3203(1), substituted "April 1, 2025" for "January 1, 2025". (American Relief Act, 2025) Law text · (l)
• Pub. L. 118–158, §3203(2), substituted "April 1, 2025" for "January 1, 2025" wherever appearing. (American Relief Act, 2025) Law text · (l)
• Pub. L. 118–158, §3207(a)(1), substituted "ending March 31, 2025" for "ending December 31, 2024". (American Relief Act, 2025) Law text · (m)
• Pub. L. 118–158, §3207(a)(2), substituted "ending on March 31, 2025" for "ending on December 31, 2024". (American Relief Act, 2025) Law text · (m)
• Pub. L. 118–158, §3207(b), substituted "ending on March 31, 2025" for "ending on December 31, 2024". (American Relief Act, 2025) Law text · (m)
• Pub. L. 118–158, §3207(d)(1), substituted "on or after April 1, 2025" for "on or after January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)" in introductory provisions. (American Relief Act, 2025) Law text · (m)
• Pub. L. 118–158, §3207(c), substituted "ending on March 31, 2025" for "ending on December 31, 2024". (American Relief Act, 2025) Law text · (m)
• Pub. L. 118–158, §3207(e), substituted "ending on March 31, 2025" for "ending on December 31, 2024". (American Relief Act, 2025) Law text · (m)
• Pub. L. 118–158, §3207(d)(3), substituted "April 1, 2025." for "January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)." (American Relief Act, 2025) Law text · (o)
• Pub. L. 118–158, §3207(d)(2), substituted "April 1, 2025." for "January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)." (American Relief Act, 2025) Law text · (y)

2022

• Pub. L. 117–328, §4133(b)(1), added cl. (iv). (Consolidated Appropriations Act, 2023) Law text · (a)
• Pub. L. 117–328, §4134(c)(2), added subpar. (E), relating to items and services related to the administration of intravenous immune globulin furnished on or after January 1, 2024, after subpar. (D). Former subpar. (E), added by Pub. L. 117–328, §4133(b)(2)(B), redesignated (F). S… (Consolidated Appropriations Act, 2023) Law text · (j)
• Pub. L. 117–328, §4133(b)(2)(B), added subpar. (E), relating to lymphedema compression treatment items, after subpar. (D). Former subpar. (E) redesignated (F). (Consolidated Appropriations Act, 2023) Law text · (j)
• Pub. L. 117–328, §4134(c)(1), redesignated subpar. (E), added by Pub. L. 117–328, §4133(b)(2)(B), relating to lymphedema compression treatment items, as (F). Former subpar. (F), as previously redesignated by Pub. L. 117–328, §4133(b)(2)(A), redesignated (G). (Consolidated Appropriations Act, 2023) Law text · (j)
• Pub. L. 117–328, §4133(b)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). (Consolidated Appropriations Act, 2023) Law text · (j)
• Pub. L. 117–328, §4134(c)(1), redesignated subpar. (F), as previously redesignated by Pub. L. 117–328, §4133(b)(2)(A), as (G). (Consolidated Appropriations Act, 2023) Law text · (j)
• Pub. L. 117–328, §4133(b)(2)(A), redesignated subpar. (F) as (G). (Consolidated Appropriations Act, 2023) Law text · (j)
• Pub. L. 117–328, §4103(1), substituted "January 1, 2025" for "January 1, 2023". (Consolidated Appropriations Act, 2023) Law text · (l)
• Pub. L. 117–328, §4103(2), substituted "January 1, 2025" for "January 1, 2023" wherever appearing. (Consolidated Appropriations Act, 2023) Law text · (l)
• Pub. L. 117–103, §311, substituted "Not later than the second June 15th following the date on which the Secretary transmits data for the first representative sample of providers and suppliers of ground ambulance services to the Medicare Payment Advisory Commission, and as det… (Consolidated Appropriations Act, 2022) Law text · (l)
• Pub. L. 117–103, §§302(1), 305(1), substituted "paragraphs (8) and (9)" for "paragraph (8)" and "(as defined in paragraph (4)(E))" for "(described in section 1395u(b)(18)(C) of this title)". (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–103, §301(b)(1), substituted "clauses (ii) and (iii)" for "clause (ii)" in introductory provisions. (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §4113(a)(1), substituted "In the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, with" for "With" and "that are furnished during the period beginning on the first day after the end of such eme… (Consolidated Appropriations Act, 2023) Law text · (m)
• Pub. L. 117–103, §301(b)(2), added cl. (iii). (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–103, §301(a)(1)(A), inserted "clause (iii) and" after "Except as provided in" in introductory provisions. (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §4113(a)(2), substituted "In the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, with" for "With" and "that are furnished during the period beginning on the first day after the end of such eme… (Consolidated Appropriations Act, 2023) Law text · (m)
• Pub. L. 117–103, §301(a)(1)(B), added cl. (iii). (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §4113(b), substituted "and, in the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, for the period beginning on the first day after the end of such emergency period and ending on December 31, 2024" … (Consolidated Appropriations Act, 2023) Law text · (m)
• Pub. L. 117–103, §302(2), inserted before period at end: "and, for the 151-day period beginning on the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title, shall include a qualified occupational therapist (as such term is used in section 1395x(g) of t… (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–103, §301(a)(2), inserted "or, for the period for which clause (iii) of paragraph (4)(C) applies, at any site described in such clause" before period at end. (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §4113(d)(1), which directed the substitution of "on or after January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)" for "on or after the day that is the 152nd day after the end o… (Consolidated Appropriations Act, 2023) Law text · (m)
• Pub. L. 117–103, §304(a), inserted "on or after the day that is the 152nd day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)" after "telehealth services furnished" in introductory provisions. (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–103, §303(1), struck out "during emergency period" after "clinics" in heading. (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §4113(c), substituted "in the case that such emergency period ends before December 31, 2024, during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024" for "during the 151-day period beginning on the first… (Consolidated Appropriations Act, 2023) Law text · (m)
• Pub. L. 117–103, §303(2), inserted "and, during the 151-day period beginning on the first day after the end of such emergency period" after "section 1320b–5(g)(1)(B) of this title" in introductory provisions. (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–103, §303(3), substituted "the periods for which subparagraph (A) applies" for "such emergency period". (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §4113(e), substituted "In the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, the Secretary shall continue to provide coverage and payment under this part for telehealth services identified in paragra… (Consolidated Appropriations Act, 2023) Law text · (m)
• Pub. L. 117–103, §305(2), added par. (9). (Consolidated Appropriations Act, 2022) Law text · (m)
• Pub. L. 117–328, §1262(b)(6), which directed substitution of "first begins prescribing narcotic drugs in schedule III, IV, or V of section 812 of title 21 for the purpose of maintenance or detoxification treatment on or after January 1, 2021" for "first receives a waiver unde… (Consolidated Appropriations Act, 2023) Law text · (o)
• Pub. L. 117–215 substituted "823(h)" for "823(g)". (Medical Marijuana and Cannabidiol Research Expansion Act) Law text · (o)
• Pub. L. 117–328, §4113(d)(3)(A), struck out "to hospice patients" after "federally qualified health centers" in heading. (Consolidated Appropriations Act, 2023) Law text · (o)
• Pub. L. 117–103, §304(c), substituted "certain" for "attending physician" in par. heading, designated existing provisions as subpar. (A) and inserted heading, and added subpar. (B). (Consolidated Appropriations Act, 2022) Law text · (o)
• Pub. L. 117–328, §4113(d)(3)(B), substituted "prior to January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)" for "prior to the day that is the 152nd day after the end of the emergency period descri… (Consolidated Appropriations Act, 2023) Law text · (o)
• Pub. L. 117–328, §4124(c)(1), added par. (5). (Consolidated Appropriations Act, 2023) Law text · (o)
• Pub. L. 117–328, §4136(a)(1), amended par. (3) generally. Prior to amendment, text read as follows: "The separate payment amount established under this paragraph for an applicable disposable device for a year shall be equal to the amount of the payment that would be made under secti… (Consolidated Appropriations Act, 2023) Law text · (s)
• Pub. L. 117–328, §4136(a)(2), added par. (4). (Consolidated Appropriations Act, 2023) Law text · (s)
• Pub. L. 117–328, §4124(c)(2)(A), which directed amendment of subsec. (y) by striking out "to hospice patients" in heading, could not be executed in view of the intervening amendment by Pub. L. 117–328, §4113(d)(2)(A). See below. (Consolidated Appropriations Act, 2023) Law text · (y)
• Pub. L. 117–328, §4113(d)(2)(A), struck out "to hospice patients" after "rural health clinics" in heading. (Consolidated Appropriations Act, 2023) Law text · (y)
• Pub. L. 117–103, §304(b), substituted "certain" for "attending physician" in heading, designated existing provisions as par. (1) and inserted heading, and added par. (2). (Consolidated Appropriations Act, 2022) Law text · (y)
• Pub. L. 117–328, §4113(d)(2)(B), substituted "prior to January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title)" for "prior to the day that is the 152nd day after the end of the emergency period described… (Consolidated Appropriations Act, 2023) Law text · (y)
• Pub. L. 117–328, §4124(c)(2)(B), added par. (3). (Consolidated Appropriations Act, 2023) Law text · (y)
• Pub. L. 117–328, §4133(a)(2)(B), added subsec. (z). (Consolidated Appropriations Act, 2023) Law text · (z)

2020

• Pub. L. 116–260, §121(b)(1), made technical correction to Pub. L. 105–33, §4552(b). See 1997 Amendment note below. (Consolidated Appropriations Act, 2021) Law text · (a)
• Pub. L. 116–260, §121(a), inserted at end "The requirement of the preceding sentence shall not apply beginning with the second calendar quarter beginning on or after December 27, 2020." (Consolidated Appropriations Act, 2021) Law text · (a)
• Pub. L. 116–260, §122(c)(1), substituted "Subject to section 1395l(a)(1)(Y) of this title, but notwithstanding" for "Notwithstanding" in introductory provisions. (Consolidated Appropriations Act, 2021) Law text · (d), (3)
• Pub. L. 116–260, §122(c)(2), substituted "Subject to section 1395l(a)(1)(Y) of this title, if during" for "If during". (Consolidated Appropriations Act, 2021) Law text · (d), (3)
• Pub. L. 116–136, §3704(1), substituted "Subject to paragraph (8), the Secretary" for "The Secretary". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (m)
• Pub. L. 116–136, §3704(2), substituted "Subject to paragraph (8), the Secretary" for "The Secretary". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (m)
• Pub. L. 116–136, §3704(3)(A), substituted "Subject to paragraph (8), the term" for "The term". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (m)
• Pub. L. 116–260, §125(c), added subcl. (XI). (Consolidated Appropriations Act, 2021) Law text · (m)
• Pub. L. 116–136, §3704(3)(B), substituted "Subject to paragraph (8), the term" for "The term". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (m)
• Pub. L. 116–260, §123(a), substituted "disorder services and mental health services furnished through telehealth" for "disorder services furnished through telehealth" in heading, designated existing provisions as subpar. (A) and inserted heading, inserted "or, on or after the first … (Consolidated Appropriations Act, 2021) Law text · (m)
• Pub. L. 116–136, §3704(4), added par. (8). (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (m)
• Pub. L. 116–260, §132(1), added par. (4). (Consolidated Appropriations Act, 2021) Law text · (o)
• Pub. L. 116–260, §125(a)(2)(B), added subsec. (x). (Consolidated Appropriations Act, 2021) Law text · (x)
• Pub. L. 116–260, §132(2), added subsec. (y). (Consolidated Appropriations Act, 2021) Law text · (y)

2018

• Pub. L. 115–123, §50411, struck out "and before October 1, 2018," after "October 1, 2015,". (Bipartisan Budget Act of 2018) Law text · (a)
• Pub. L. 115–123, §50402, added par. (5). (Bipartisan Budget Act of 2018) Law text · (h)
• Pub. L. 115–123, §50203(a)(2), substituted "2023" for "2018". (Bipartisan Budget Act of 2018) Law text · (l)
• Pub. L. 115–123, §50203(a)(1), substituted "2023" for "2018" wherever appearing. (Bipartisan Budget Act of 2018) Law text · (l)
• Pub. L. 115–123, §53108, substituted "during the period beginning on October 1, 2013, and ending on September 30, 2018, and by 23 percent for such services furnished on or after October 1, 2018" for "on or after October 1, 2013". (Bipartisan Budget Act of 2018) Law text · (l)
• Pub. L. 115–123, §50203(b), added par. (17). (Bipartisan Budget Act of 2018) Law text · (l)
• Pub. L. 115–123, §50302(b)(2), redesignated existing provisions as cl. (i), inserted heading, substituted "Subject to clause (ii), with respect to" for "With respect to", redesignated former cls. (i) and (ii) as subcls. (I) and (II), respectively, of cl. (i), substituted "subclau… (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–271, §2001(a)(1)(A), substituted "clause (ii) and paragraph (6)(C)" for "clause (ii)" in introductory provisions. (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–271, §2001(a)(1)(B), struck out "for home dialysis therapy" after "site" in heading. (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–271, §2001(a)(2)(A), substituted "paragraphs (5), (6), and (7)" for "paragraph (6)" in introductory provisions. (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–123, §50325(1), substituted "Except as provided in paragraph (6), the term" for "The term" in introductory provisions. (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–123, §50302(b)(1)(A), added subcl. (IX). (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–271, §2001(a)(2)(B), inserted "or telehealth services described in paragraph (7)" before period at end. (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–123, §50302(b)(1)(A), added subcl. (X). (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–123, §50302(b)(1)(B), added par. (5). (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–123, §50325(2), added par. (6). (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–271, §2001(a)(3), added par. (7). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–271, §6083(a), added par. (3). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (o)
• Pub. L. 115–123, §50401(a), added par. (7). (Bipartisan Budget Act of 2018) Law text · (u)
• Pub. L. 115–123, §53107, added subsec. (v). (Bipartisan Budget Act of 2018) Law text · (v)
• Pub. L. 115–271, §2005(c)(2), added subsec. (w). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (w)

2016

• Pub. L. 114–255, §16008(a), inserted at end "In the case of items and services furnished on or after January 1, 2019, in making any adjustments under clause (ii) or (iii) of subparagraph (F), under subsection (h)(1)(H)(ii), or under section 1395u(s)(3)(B) of this title, the Secre… (21st Century Cures Act) Law text · (a)
• Pub. L. 114–255, §16008(b)(1), substituted "subject to subsection (a)(1)(G), the Secretary" for "the Secretary". (21st Century Cures Act) Law text · (h)
• Pub. L. 114–255, §4011, added subsec. (t). (21st Century Cures Act) Law text · (t)
• Pub. L. 114–255, §5012(b), added subsec. (u). (21st Century Cures Act) Law text · (u)

2015

• Pub. L. 114–40 added cl. (iv). (Steve Gleason Act of 2015) Law text · (a)
• Pub. L. 114–10, §504(a), struck out "the physician documenting that" after "written pursuant to" and substituted "documenting such physician, physician assistant, practitioner, or specialist has had a face-to-face encounter" for "has had a face-to-face encounter". (Medicare Access and CHIP Reauthorization Act of 2015) Law text · (a)
• Pub. L. 114–10, §203(b), substituted "January 1, 2018" for "April 1, 2015". (Medicare Access and CHIP Reauthorization Act of 2015) Law text · (l)
• Pub. L. 114–10, §203(a), substituted "January 1, 2018" for "April 1, 2015" wherever appearing. (Medicare Access and CHIP Reauthorization Act of 2015) Law text · (l)
• Pub. L. 114–10, §515(b), added par. (16). (Medicare Access and CHIP Reauthorization Act of 2015) Law text · (l)
• Pub. L. 114–27 added subsec. (r). (Trade Preferences Extension Act of 2015) Law text · (r)
• Pub. L. 114–113 added subsec. (s). (Consolidated Appropriations Act, 2016) Law text · (s)

2014

• Pub. L. 113–295 added subpar. (I). Law text · (a)
• Pub. L. 113–93, §104(b), substituted "April 1, 2015" for "April 1, 2014". (Protecting Access to Medicare Act of 2014) Law text · (l)
• Pub. L. 113–93, §104(a), substituted "April 1, 2015" for "April 1, 2014" wherever appearing. (Protecting Access to Medicare Act of 2014) Law text · (l)
• Pub. L. 113–93, §218(a)(1), added subsec. (p). (Protecting Access to Medicare Act of 2014) Law text · (p)
• Pub. L. 113–93, §218(b)(1), added subsec. (q). (Protecting Access to Medicare Act of 2014) Law text · (q)

2013

• Pub. L. 112–240, §636(a)(1), substituted "subparagraphs (G) and (H)" for "subparagraph (G)" in introductory provisions. (American Taxpayer Relief Act of 2012) Law text · (a)
• Pub. L. 112–240, §636(a)(2), added subpar. (H). (American Taxpayer Relief Act of 2012) Law text · (a)
• Pub. L. 112–240, §636(b), added par. (22). (American Taxpayer Relief Act of 2012) Law text · (a)
• Pub. L. 112–240, §633(b), added par. (7). (American Taxpayer Relief Act of 2012) Law text · (k)
• Pub. L. 113–67, §1104(b), substituted "April 1, 2014" for "January 1, 2014". Law text · (l)
• Pub. L. 112–240, §604(c), substituted "January 1, 2014" for "January 1, 2013". (American Taxpayer Relief Act of 2012) Law text · (l)
• Pub. L. 113–67, §1104(a), substituted "April 1, 2014" for "January 1, 2014" wherever appearing. Law text · (l)
• Pub. L. 112–240, §604(a), substituted "January 1, 2014" for "January 1, 2013" wherever appearing. (American Taxpayer Relief Act of 2012) Law text · (l)
• Pub. L. 112–240, §637, added par. (15). (American Taxpayer Relief Act of 2012) Law text · (l)

2012

• Pub. L. 112–96, §3007(c), substituted "January 1, 2013" for "March 1, 2012". (Middle Class Tax Relief and Job Creation Act of 2012) Law text · (l)
• Pub. L. 112–96, §3007(a), substituted "January 1, 2013" for "March 1, 2012" wherever appearing. (Middle Class Tax Relief and Job Creation Act of 2012) Law text · (l)

2011

• Pub. L. 112–78, §306(c), substituted "March 1, 2012" for "January 1, 2012". (Temporary Payroll Tax Cut Continuation Act of 2011) Law text · (l)
• Pub. L. 112–78, §306(a), substituted "March 1, 2012" for "January 1, 2012" wherever appearing. (Temporary Payroll Tax Cut Continuation Act of 2011) Law text · (l)

2010

• Pub. L. 111–148, §6410(b)(2)(A), inserted "(and, in the case of covered items furnished on or after January 1, 2016, subject to clause (iii), shall)" after "may". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6410(b)(1), (2)(B), (3), added cl. (iii). (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3136(a)(1)(A), inserted "subclause (III) and" after "Subject to". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3136(a)(1)(B), added subcl. (III). (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3136(a)(2)(B), inserted "complex, rehabilitative" after "case of a". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3136(a)(2)(A), inserted "complex, rehabilitative" after "option for" in heading. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3136(b), struck out "(A)(ii) or" after "subparagraph". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6407(b)(1), designated existing provisions as cl. (i) and inserted heading. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6405(a), substituted "physician enrolled under section 1395cc(j) of this title or an eligible professional under section 1395w–4(k)(3)(B) of this title that is enrolled under section 1395cc(j) of this title" for "physician". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6407(b)(2), added cl. (ii). (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3401(m)(3), inserted concluding provisions. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3401(m)(1), struck out "2011, 2012, and 2013," after "2010," and inserted "and" at the end. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3401(m)(2), added subpar. (L) and struck out former subpars. (L) and (M) which read as follows: (Patient Protection and Affordable Care Act) Law text · (a), (M)
• Pub. L. 111–148, §6402(g)(1), inserted "that the Secretary determines is commensurate with the volume of the billing of the supplier" after "$50,000". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3109(a)(1)(B), which directed amendment by inserting ", except that the Secretary shall not require a pharmacy to have submitted to the Secretary such evidence of accreditation prior to January 1, 2011" before semicolon "at the end", was executed by making t… (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3109(a)(1)(A), inserted "and subparagraph (G)" after "clause (ii)". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3109(a)(2), added subpar. (G). (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3128(a), inserted "101 percent of" after "subparagraph (B),". (Patient Protection and Affordable Care Act) Law text · (g)
• Pub. L. 111–148, §5501(b)(2), substituted "Subsections (x) and (y) of section 1395l" for "Section 1395l(x)". (Patient Protection and Affordable Care Act) Law text · (g)
• Pub. L. 111–148, §5501(a)(2), inserted at end "Section 1395l(x) of this title shall not be taken into account in determining the amounts that would otherwise be paid pursuant to the preceding sentence." (Patient Protection and Affordable Care Act) Law text · (g)
• Pub. L. 111–148, §3401(n)(1)(D), inserted concluding provisions. (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §3401(n)(1)(B)(i), substituted "for each of 2007 through 2010" for "a subsequent year". (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §3401(n)(1)(A), (B)(ii), (C), added cl. (xi). (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §3401(j)(4), inserted concluding provisions. (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–148, §3401(j)(2)(A), inserted ", subject to subparagraph (C) and the succeeding sentence of this paragraph," after "increased". (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–148, §3401(j)(1), (2)(B), (3), added subpar. (C). (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–148, §3128(a), inserted "101 percent of" after "pay" in introductory provisions. (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–309, §106(c), substituted "2012" for "2011". (Medicare and Medicaid Extenders Act of 2010) Law text · (l)
• Pub. L. 111–148, §10311(c), substituted "2011" for "2010, and on or after April 1, 2010, and before January 1, 2011". (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–148, §3105(c), substituted "2010, and on or after April 1, 2010, and before January 1, 2011" for "2010". (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–309, §106(a)(1), substituted "2012," for "2011" in introductory provisions. (Medicare and Medicaid Extenders Act of 2010) Law text · (l)
• Pub. L. 111–148, §10311(a)(1), in introductory provisions, substituted "2007, and for" for "2007, for" and "2011" for "2010, and for such services furnished on or after April 1, 2010, and before January 1, 2011". (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–148, §3105(a)(1), in introductory provisions, substituted "2007, for" for "2007, and for" and "2010, and for such services furnished on or after April 1, 2010, and before January 1, 2011," for "2010". (Patient Protection and Affordable Care Act) Law text · (l)
• Pub. L. 111–309, §106(a)(2), substituted "January 1, 2012" for "January 1, 2011". (Medicare and Medicaid Extenders Act of 2010) Law text · (l), (ii)
• Pub. L. 111–148, §10311(a)(2)(B), substituted "January 1, 2011" for "January 1, 2010". (Patient Protection and Affordable Care Act) Law text · (l), (ii)
• Pub. L. 111–148, §10311(a)(2)(A), struck out ", and on or after April 1, 2010, and before January 1, 2011" after "January 1, 2010". (Patient Protection and Affordable Care Act) Law text · (l), (ii)
• Pub. L. 111–148, §3105(a)(2), inserted ", and on or after April 1, 2010, and before January 1, 2011" after "January 1, 2010". (Patient Protection and Affordable Care Act) Law text · (l), (ii)
• Pub. L. 111–148, §5502(b), which directed the addition of subsec. (n) relating to development and implementation of prospective payment system, was repealed by Pub. L. 111–148, §10501(i)(1). (Patient Protection and Affordable Care Act) Law text · (n)
• Pub. L. 111–148, §4105(a), added subsec. (n) relating to authority to modify or eliminate coverage of certain preventive services. (Patient Protection and Affordable Care Act) Law text · (n)
• Pub. L. 111–148, §10501(i)(3)(A), added subsec. (o). (Patient Protection and Affordable Care Act) Law text · (o)

2009

• Pub. L. 111–72 inserted ", except that the Secretary shall not require under this clause pharmacies to obtain such accreditation before January 1, 2010" before semicolon. Law text · (a)

2008

• Pub. L. 110–275, §154(d)(2), substituted "1395x(r)" for "1395x(r)(1)". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §154(a)(3), (4)(A)(i), in introductory provisions, substituted "January 1, 2011" for "January 1, 2009" and inserted "subject to subparagraph (G)," before "that are included". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §154(a)(4)(A)(ii), added subpar. (G). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §144(b)(1), substituted "Rental cap" for "Ownership of equipment" in heading, added cl. (ii), and struck out former cl. (ii) which related to transfer of title to equipment and payments for oxygen and maintenance and servicing. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §154(a)(2)(A), added subpars. (J) to (L) and redesignated former subpar. (J) as (M). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §125(b)(5), substituted "section 1395bb(a)" for "section 1395bb(b)". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §154(b)(1)(A)(i), inserted "including subparagraph (F)," after "under this paragraph,". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §154(b)(1)(A)(ii), added subpar. (F). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §135(a)(1), added subsec. (e). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §148(a), substituted "Treatment of" for "No beneficiary cost-sharing for" in heading and inserted at end "For purposes of the preceding sentence and section 1395x(mm)(3) of this title, clinical diagnostic laboratory services furnished by a critical access hospital s… (Medicare Improvements for Patients and Providers Act of 2008) Law text · (g)
• Pub. L. 110–275, §154(a)(3), (4)(B), in introductory provisions, substituted "January 1, 2011" for "January 1, 2009" and inserted "subject to subsection (a)(1)(G)," before "that are included". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (h)
• Pub. L. 110–275, §146(a)(1), inserted "and for such services furnished on or after July 1, 2008, and before January 1, 2010" after "2007," in introductory provisions, "(or 3 percent if such service is furnished on or after July 1, 2008, and before January 1, 2010)" after "2 perc… (Medicare Improvements for Patients and Providers Act of 2008) Law text · (l)
• Pub. L. 110–275, §146(a)(2), substituted "applicable period" for "2006" in heading and inserted "applicable" before "period" in text. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (l)
• Pub. L. 110–275, §146(b)(2)(A), substituted "certifies or reasonably determines" for "reasonably determines or certifies". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (l)
• Pub. L. 110–275, §149(a), added subcls. (VI) to (VIII). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (m)

2006

• Pub. L. 109–171, §5101(b)(1)(A), substituted "(E), and (F)" for "and (E)". (Deficit Reduction Act of 2005) Law text · (a)
• Pub. L. 109–171, §5101(b)(1)(B), added subpar. (F). (Deficit Reduction Act of 2005) Law text · (a)
• Pub. L. 109–171, §5101(a)(1), amended heading and text of subpar. (A) generally, revising and restating as cls. (i) to (iv) provisions of former cls. (i) to (vi). (Deficit Reduction Act of 2005) Law text · (a)
• Pub. L. 109–171, §5113(b), struck out "deductible and" before "coinsurance" in heading and struck out "deductible or" before "copayment" and before "coinsurance" in subcl. (I). (Deficit Reduction Act of 2005) Law text · (d)
• Pub. L. 109–171, §5113(b), struck out "deductible and" before "coinsurance" in heading and struck out "deductible or" before "coinsurance" in two places in subcl. (I). (Deficit Reduction Act of 2005) Law text · (d)

2003

• Pub. L. 108–173, §302(d)(1)(A), substituted "Subject to subparagraph (F)(i), the payment basis" for "The payment basis" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(d)(1)(B), substituted "Subject to subparagraph (F)(ii), this subsection" for "This subsection". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(a)(2), added subpar. (E). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(d)(1)(C), added subpar. (F). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(d)(1)(D), inserted "in an area and with respect to covered items and services for which the Secretary does not make a payment amount adjustment under paragraph (1)(F)" after "under this subsection". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(c)(1)(A)(ii), substituted "2003" for "a subsequent year" and "2002;" for "the previous year." (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(c)(1)(A)(i), (iii), added subpars (G) to (J). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(a)(1)(A), redesignated par. (17), relating to certain upgraded items, as (19) and transferred it to the end of subsec. (a). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a), (19)
• Pub. L. 108–173, §302(a)(1)(B), added par. (20). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §302(c)(2), added par. (21). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §736(b)(4), substituted "clause (vi)" for "clauses (vi)". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §405(a)(1), inserted "equal to 101 percent of" before "the reasonable costs". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (g)
• Pub. L. 108–173, §405(d)(1), inserted concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (g)
• Pub. L. 108–173, §405(b)(1), in heading, inserted "certain" before "emergency" and substituted "providers" for "physicians", and, in text, substituted "physicians, physician assistants, nurse practitioners, and clinical nurse specialists who are on-call (as defined by the Secretary)… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (g)
• Pub. L. 108–173, §302(d)(2)(A), substituted ", (E), and (H)(i)" for "and (E)" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §302(d)(2)(B), substituted "Subject to subparagraph (H)(ii), this subsection" for "This subsection". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §302(d)(2)(C), added subpar. (H). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §302(c)(3)(B), substituted "2003" for "a subsequent year". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §302(c)(3)(A), (C), added cls. (ix) and (x). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h), (x)
• Pub. L. 108–173, §627(b)(1), inserted "(and includes shoes described in section 1395x(s)(12) of this title)" after "in section 1395x(s)(9) of this title". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §414(a)(1), inserted "consistent with paragraph (11)" after "in an efficient and fair manner". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §414(a)(2), redesignated par. (8), relating to transitional assistance for rural providers, as (9). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l), (9)
• Pub. L. 108–173, §414(a)(3), added par. (10). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §414(b), added par. (11). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §414(c)(1), added par. (12). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §414(d), added par. (13). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §415(a), added par. (14). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §736(b)(5), substituted "1395x(aa)(2)" for "1395x(aa)(s)". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (m)

2000

• Pub. L. 106–554, §1(a)(6) [title IV, §425(a)(2)], substituted "through 2000" for "through 2002" and struck out "and" at end. (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title IV, §425(a)(1), (3)], added subpars. (D) and (E) and redesignated former subpar. (D) as (F). (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title I, §104(b)], amended heading and text generally, substituting present provisions for provisions which had set forth similar standards for screening mammography but had provided for payment limited to 80 percent of the least of the actual charge, a statu… (Consolidated Appropriations Act, 2001) Law text · (c)
• Pub. L. 106–554, §1(a)(6) [title I, §103(b)(1)], inserted before period at end "or, in the case of an individual who is not at high risk for colorectal cancer, if the procedure is performed within the 119 months after a previous screening colonoscopy". (Consolidated Appropriations Act, 2001) Law text · (d)
• Pub. L. 106–554, §1(a)(6) [title I, §103(b)(2)(A)], struck out "for individuals at high risk for colorectal cancer" after "colonoscopy" in heading. (Consolidated Appropriations Act, 2001) Law text · (d)
• Pub. L. 106–554, §1(a)(6) [title I, §103(b)(2)(B)], struck out "for individuals at high risk for colorectal cancer (as defined in section 1395x(pp)(2) of this title)" after "screening colonoscopy". (Consolidated Appropriations Act, 2001) Law text · (d)
• Pub. L. 106–554, §1(a)(6) [title I, §103(b)(2)(C)], inserted before period at end "or for other individuals if the procedure is performed within the 119 months after a previous screening colonoscopy or within 47 months after a previous screening flexible sigmoidoscopy". (Consolidated Appropriations Act, 2001) Law text · (d)
• Pub. L. 106–554, §1(a)(6) [title II, §202(a)], inserted "115 percent of" before "such amounts". (Consolidated Appropriations Act, 2001) Law text · (g)
• Pub. L. 106–554, §1(a)(6) [title II, §201(a)], added par. (4). (Consolidated Appropriations Act, 2001) Law text · (g)
• Pub. L. 106–554, §1(a)(6) [title II, §204(a)], added par. (5). (Consolidated Appropriations Act, 2001) Law text · (g)
• Pub. L. 106–554, §1(a)(6) [title IV, §427(a)], added subpar. (F). (Consolidated Appropriations Act, 2001) Law text · (h)
• Pub. L. 106–554, §1(a)(6) [title IV, §428(a)], added subpar. (G). (Consolidated Appropriations Act, 2001) Law text · (h)
• Pub. L. 106–554, §1(a)(6) [title IV, §426(a)(2)], substituted "through 2000" for "through 2002" and struck out "and" at end. (Consolidated Appropriations Act, 2001) Law text · (h)
• Pub. L. 106–554, §1(a)(6) [title IV, §426(a)(1), (3)], added cls. (vi) and (vii) and redesignated former cl. (vi) as (viii). (Consolidated Appropriations Act, 2001) Law text · (h)
• Pub. L. 106–554, §1(a)(6) [title IV, §423(b)(1)], inserted before period at end ", except that such phase-in shall provide for full payment of any national mileage rate for ambulance services provided by suppliers that are paid by carriers in any of the 50 States where payment by… (Consolidated Appropriations Act, 2001) Law text · (l)
• Pub. L. 106–554, §1(a)(6) [title IV, §423(a)(1)], substituted "reduced in the case of 2002" for "reduced in the case of 2001 and 2002". (Consolidated Appropriations Act, 2001) Law text · (l), (B)
• Pub. L. 106–554, §1(a)(6) [title II, §221(a)], added par. (8) relating to transitional assistance for rural providers. (Consolidated Appropriations Act, 2001) Law text · (l)
• Pub. L. 106–554, §1(a)(6) [title II, §205(a)], added par. (8) relating to services furnished by critical access hospitals. (Consolidated Appropriations Act, 2001) Law text · (l)
• Pub. L. 106–554, §1(a)(6) [title II, §223(b)], added subsec. (m). (Consolidated Appropriations Act, 2001) Law text · (m)

1999

• Pub. L. 106–113, §1000(a)(6) [title II, §201(e)(2)(A)], substituted "1395x(m)(5) of this title, but not including implantable items for which payment may be made under section 1395l(t) of this title" for "1395x(m)(5) of this title)". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (a)
• Pub. L. 106–113, §1000(a)(6) [title IV, §403(d)(1)], amended heading and text of subsec. (g) generally. Prior to amendment, text read as follows: "The amount of payment under this part for outpatient critical access hospital services is the reasonable costs of the critical access hospi… (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (g)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(3)(A)], substituted semicolon for comma at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (h)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(3)(B)], substituted "; and" for ", and" at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (h)
• Pub. L. 106–113, §1000(a)(6) [title II, §201(e)(2)(B)], inserted "and does not include an implantable item for which payment may be made under section 1395l(t) of this title" before the semicolon. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (h)

1997

• Pub. L. 105–33, §4105(b)(2), inserted before period at end "(reduced by 10 percent, in the case of a blood glucose testing strip furnished after 1997 for an individual with diabetes)". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4552(a)(2)(A), substituted "1995, 1996, and 1997" for "each subsequent year". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4552(a)(1), (2)(B), (3), added cls. (v) and (vi). (Balanced Budget Act of 1997) Law text · (a), (vi)
• Pub. L. 105–33, §4552(b), as amended by Pub. L. 116–260, §121(b)(1), added subpar. (D). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4316(b), substituted "The Secretary" for "For covered items furnished on or after January 1, 1991, the Secretary" and struck out "(other than subparagraph (D))" before "of section 1395u(b) of this title" and "as such provisions would otherwise apply to physician… (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4551(a)(1)(B)(i), substituted "1993, 1994, 1995, 1996, and 1997" for "a subsequent year". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4551(a)(1)(A), (B)(ii), (C), added subpars. (C) and (D). (Balanced Budget Act of 1997) Law text · (a), (D)
• Pub. L. 105–33, §4312(c), inserted at end "The Secretary, at the Secretary's discretion, may impose the requirements of the first sentence with respect to some or all providers of items or services under part A or some or all suppliers or other persons (other than physicians or oth… (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4312(a), added par. (16). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4551(c)(1), added par. (17) relating to certain upgraded items. (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4101(c), in introductory provisions, struck out ", subject to the deductible established under section 1395l(b) of this title," before "be equal to 80". (Balanced Budget Act of 1997) Law text · (c)
• Pub. L. 105–33, §4101(a)(1), amended cl. (iii) generally. Prior to amendment, cl. (iii) read as follows: "In the case of a woman over 39 years of age, but under 50 years of age, who— (Balanced Budget Act of 1997) Law text · (c)
• Pub. L. 105–33, §4101(a)(2), struck out cls. (iv) and (v), which read as follows: (Balanced Budget Act of 1997) Law text · (c), (v)
• Pub. L. 105–33, §4104(b)(1), added subsec. (d). (Balanced Budget Act of 1997) Law text · (d)
• Pub. L. 105–33, §4201(c)(5), amended heading and text of subsec. (g) generally. Prior to amendment, text related to payment for outpatient rural primary care hospital services as determined, in par. (1), by either the cost-based facility fee plus professional charges method or the all-… (Balanced Budget Act of 1997) Law text · (g)
• Pub. L. 105–33, §4551(a)(2)(B), substituted "1996 and 1997" for "a subsequent year". (Balanced Budget Act of 1997) Law text · (h)
• Pub. L. 105–33, §4551(a)(2)(A), (C), added cls. (v) and (vi). (Balanced Budget Act of 1997) Law text · (h), (vi)
• Pub. L. 105–33, §4541(a)(2), added subsec. (k). (Balanced Budget Act of 1997) Law text · (k)
• Pub. L. 105–33, §4531(b)(2), added subsec. (l). (Balanced Budget Act of 1997) Law text · (l)

1994

• Pub. L. 103–432, §135(e)(5), struck out heading and text of subpar. (D). Text read as follows: "If the reasonable useful lifetime of such an item, as established under paragraph (7)(C), has been reached during a continuous period of medical need, or the Secretary determines on th… · (a)
• Pub. L. 103–432, §135(d)(1), substituted "pressure of 56" for "pressure of 55". · (a)
• Pub. L. 103–432, §135(e)(2), made technical amendment to directory language of Pub. L. 101–508, §4152(c)(2). See 1990 Amendment note below. · (a)
• Pub. L. 103–432, §135(e)(3), substituted "clause (vi)" for "clause (v)". · (a)
• Pub. L. 103–432, §135(e)(4), substituted "this paragraph" for "this paragraph or paragraph (3)". · (a)
• Pub. L. 103–432, §134(a)(1), inserted at end "In applying such provisions to payments for an item under this subsection, the Secretary shall make adjustments to the payment basis for the item described in paragraph (1)(B) if the Secretary determines (in accordance with such prov… · (a)
• Pub. L. 103–432, §126(g)(10)(B), substituted "would otherwise apply to physicians' services" for "apply to physicians' services" and inserted before period at end "but for the application of section 1395w–4(i)(3) of this title". · (a)
• Pub. L. 103–432, §135(a)(1), amended subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: "for 1991 and 1992, reduction of 1 percentage point; and". · (a)
• Pub. L. 103–432, §135(b)(1), amended heading and text of par. (15) generally. Prior to amendment, text read as follows: · (a)
• Pub. L. 103–432, §131(a)(2), struck out heading and text of par. (16). Text read as follows: · (a)
• Pub. L. 103–432, §132(a)(1), (2), added pars. (17) and (18). · (a), (18)
• Pub. L. 103–432, §126(b)(2)(A), in introductory provisions substituted "shall, subject to clause (vii), be reduced to the adjusted conversion factor for the locality determined as follows:" for "shall be determined as follows:". · (b)
• Pub. L. 103–432, §126(b)(2)(B), substituted "Adjusted conversion factor" for "Local adjustment" in heading and "The adjusted conversion factor for" for "Subject to clause (vii), the conversion factor to be applied to" in text. · (b)
• Pub. L. 103–432, §126(b)(2)(C), (D), struck out "under this subparagraph" after "applied to a locality" and inserted "reduced under this subparagraph by" before "more than 9.5 percent". · (b)
• Pub. L. 103–432, §126(b)(5), inserted heading "Rule for certain scanning services". · (b)
• Pub. L. 103–432, §126(b)(4), made technical amendment to directory language of Pub. L. 101–508, §4102(d). See 1990 Amendment note below. · (b)
• Pub. L. 103–432, §126(b)(1), redesignated subpar. (E), relating to subsequent updating, as (F). · (b)
• Pub. L. 103–432, §126(b)(1), redesignated subpars. (E), relating to subsequent updating, and (F) as (F) and (G), respectively. · (b), (G)
• Pub. L. 103–432, §145(a)(1), substituted "is conducted by a facility that has a certificate (or provisional certificate) issued under section 263b of this title" for "meets the quality standards established under paragraph (3)". · (c)
• Pub. L. 103–432, §145(a)(2), substituted "paragraph (3)" for "paragraph (4)". · (c)
• Pub. L. 103–432, §145(a)(3), (4), redesignated pars. (4) and (5) as (3) and (4), respectively, and struck out former par. (3) which directed Secretary to establish standards to assure the safety and accuracy of screening mammography performed under this part. · (c)
• Pub. L. 103–432, §126(g)(1), substituted "during 1991" for "during fiscal year 1991" in heading. · (f)
• Pub. L. 103–432, §102(e)(1)(A), (2), substituted in introductory provisions "during a year before the prospective payment system described in paragraph (2) is in effect" for "during a year before 1993" and inserted at end "The amount of payment shall be determined under either metho… · (g)
• Pub. L. 103–432, §156(a)(2)(C), struck out "and for items and services furnished in connection with obtaining a second opinion required under section 1320c–13(c)(2) of this title, or a third opinion, if the second opinion was in disagreement with the first opinion" after "section… · (g)
• Pub. L. 103–432, §102(e)(1)(B), substituted "January 1, 1996" for "January 1, 1993". · (g)
• Pub. L. 103–432, §135(b)(3), substituted "Paragraphs (12), (15), and (17)" for "Paragraphs (12) and (17)". · (h)
• Pub. L. 103–432, §132(b), substituted "Paragraphs (12) and (17)" for "Paragraph (12)". · (h)
• Pub. L. 103–432, §131(a)(1), added subsec. (j). · (j)
• Pub. L. 103–432, §133(a)(1), added par. (4) and redesignated former par. (4) as (5). · (j), (5)

1993

• Pub. L. 103–66, §13545(a), substituted "45 percent" for "15 percent" after "(as previously reduced) by". · (a)
• Pub. L. 103–66, §13543(b), added cl. (iii). · (a)
• Pub. L. 103–66, §13542(a)(1), in cl. (i)(II), substituted "for 1992, 1993, and 1994" for "for 1992" and "update for the year" for "update for 1992", and in cl. (ii), struck out "and" at end of subcl. (I), added subcls. (II) and (III), and redesignated former subcl. (II) as (IV). · (a)
• Pub. L. 103–66, §13543(a), substituted "IPPB machines and ventilators, excluding ventilators that are either continuous airway pressure devices or intermittent assist devices with continuous airway pressure devices" for "ventilators, aspirators, IPPB machines, and nebulizers". · (a)
• Pub. L. 103–66, §13542(a)(1), in cl. (i)(II), substituted "for 1992, 1993, and 1994" for "for 1992" and "update for the year" for "update for 1992", and in cl. (ii), struck out "and" at end of subcl. (I), added subcls. (II) and (III), and redesignated former subcl. (II) as (IV). · (a)
• Pub. L. 103–66, §13542(a)(2)(A), substituted "1992, 1993, and 1994" for "1992". · (a)
• Pub. L. 103–66, §13542(a)(2)(B), added cls. (ii) and (iii) and redesignated former cl. (ii) as (iv). · (a)
• Pub. L. 103–66, §13542(a)(3)(A), substituted "1991, 1992, 1993, and 1994" for "1991 and 1992". · (a)
• Pub. L. 103–66, §13542(a)(3)(B), added cls. (ii) and (iii) and redesignated former cl. (ii) as (iv). · (a)
• Pub. L. 103–66, §13544(a)(2), substituted "subparagraphs (C) and (E)" for "subparagraph (C)" in introductory provisions. · (h)
• Pub. L. 103–66, §13544(a)(1), added subpar. (E). · (h)
• Pub. L. 103–66, §13546, struck out "and" at end of cl. (i), substituted "1992 and 1993" for "a subsequent year" in cl. (ii), and added cls. (iii) and (iv). · (h)
• Pub. L. 103–66, §13544(b)(1), added subsec. (i). · (i)

1990

• Pub. L. 101–508, §4153(a)(2)(D)(i), struck out ", prosthetic devices, orthotics, and prosthetics" after "medical equipment" in heading. · (a)
• Pub. L. 101–508, §4152(a)(1), inserted before period at end ", and, in the case of a transcutaneous electrical nerve stimulator furnished on or after January 1, 1991, the Secretary shall further reduce such payment amount (as previously reduced) by 15 percent". · (a)
• Pub. L. 101–508, §4153(a)(2)(D)(ii), substituted "(13)" for "(13)(A)". · (a)
• Pub. L. 101–508, §4152(c)(4)(A), inserted "or" after "$150," in cl. (i), struck out "or" after "purchase," in cl. (ii), and struck out cl. (iii) which read as follows: "which is a power-driven wheelchair (other than a customized wheelchair that is classified as a customized item under paragraph (4)… · (a)
• Pub. L. 101–508, §4152(b)(1)(A), (B), struck out "or" after "1987;" in cl. (i), added cls. (ii) to (iv), and struck out former cl. (ii) which read as follows: "in a subsequent year, is the amount specified in this subparagraph for the preceding year increased by the percentage in… · (a)
• Pub. L. 101–508, §4152(b)(1)(C), added subpar. (C). · (a)
• Pub. L. 101–508, §4152(b)(1)(A), (B), struck out "or" after "1987;" in cl. (i), added cls. (ii) to (iv), and struck out former cl. (ii) which read as follows: "in a subsequent year, is the amount specified in this subparagraph for the preceding year increased by the percentage in… · (a)
• Pub. L. 101–508, §4152(b)(1)(C), added subpar. (C). · (a)
• Pub. L. 101–508, §4152(c)(3), added subpar. (D). · (a)
• Pub. L. 101–508, §4152(c)(4)(B)(i), directed amendment of par. (4) by inserting at end "In the case of a wheelchair furnished on or after January 1, 1992, the wheelchair shall be treated as a customized item for purposes of this paragraph if the wheelchair has been measured, fitted,… · (a)
• Pub. L. 101–508, §4152(g)(1)(A), substituted "(B), (C), and (E)" for "(B) and (C)". · (a)
• Pub. L. 101–508, §4152(g)(1)(B), added subpar. (E). · (a)
• Pub. L. 101–508, §4152(c)(2)(A), as amended by Pub. L. 103–432, §135(e)(2), substituted "15 months, or, in the case of an item for which a purchase agreement has been entered into under clause (iii), a period of continuous use of longer than 13 months" for "15 months". · (a)
• Pub. L. 101–508, §4152(c)(1), substituted "for each of the first 3 months of such period" for "for each such month" and ", and for each of the remaining months of such period is 7.5 percent of such purchase price;" for semicolon at end. · (a)
• Pub. L. 101–508, §4152(c)(2)(D), as amended by Pub. L. 103–432, §135(e)(2), added cls. (ii) and (iii). Former cls. (ii) and (iii) redesignated (iv) and (v), respectively. · (a), (iii)
• Pub. L. 101–508, §4152(c)(2)(B), as amended by Pub. L. 103–432, §135(e)(2), redesignated cl. (ii) as (iv), substituted "in the case of an item for which a purchase agreement has not been entered into under clause (ii) or clause (iii), during the first 6-month period of medica… · (a)
• Pub. L. 101–508, §4152(c)(2)(C), as amended by Pub. L. 103–432, §135(e)(2), redesignated cl. (iii) as (v), inserted at beginning "in the case of an item for which a purchase agreement has not been entered into under clause (ii) or clause (iii),", and substituted "; and" for pe… · (a)
• Pub. L. 101–508, §4152(c)(2)(E), as amended by Pub. L. 103–432, §135(e)(2), added cl. (vi). · (a)
• Pub. L. 101–508, §4152(c)(2)(F), as amended by Pub. L. 103–432, §135(e)(2), added subpar. (C). · (a)
• Pub. L. 101–508, §4152(b)(2)(A), added subcl. (II), redesignated former subcl. (II) as (III), struck out "1991 or" before "1992", and substituted "the covered item update for the year" for "the percentage increase in the consumer price index for all urban consumers (U.S. city… · (a)
• Pub. L. 101–508, §4152(b)(2)(B), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: "With respect to the furnishing of a particular item in each region (as defined by the Secretary), the Secretary shall compute a regional purchase price— · (a)
• Pub. L. 101–508, §4152(b)(2)(C)(ii), struck out "and subject to subparagraph (D)" after "and (7)" in introductory provisions. · (a)
• Pub. L. 101–508, §4152(b)(2)(C)(i), (iii), in subcl. (I) substituted "67 percent" for "75 percent" and in subcl. (II) substituted "33 percent" for "25 percent" and "national limited purchase price" for "regional purchase price". · (a)
• Pub. L. 101–508, §4152(b)(2)(C)(i), (iv), in subcl. (I) substituted "33 percent" for "50 percent" and "subparagraph (A)(ii)(III)" for "subparagraph (A)(ii)(II)" and in subcl. (II) substituted "67 percent" for "50 percent" and "national limited purchase price" for "regional p… · (a)
• Pub. L. 101–508, §4152(b)(2)(C)(i), substituted "national limited purchase price" for "regional purchase price". · (a)
• Pub. L. 101–508, §4152(b)(2)(D), struck out subpar. (D) which read as follows: "The amount that is recognized under subparagraph (C) as the purchase price for an item furnished— · (a)
• Pub. L. 101–508, §4152(b)(3)(A), substituted "the covered item increase for the year" for "the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year". · (a)
• Pub. L. 101–508, §4152(b)(3)(B), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: "With respect to the furnishing of an item in each region (as defined by the Secretary), the Secretary shall compute a regional monthly payment rate— · (a)
• Pub. L. 101–508, §4152(b)(3)(C)(i), (ii), in subcl. (I) substituted "67 percent" for "75 percent" and in subcl. (II) substituted "33 percent" for "25 percent" and "national limited monthly payment rate" for "regional monthly payment rate". · (a)
• Pub. L. 101–508, §4152(b)(3)(C)(i), (iii), in subcl. (I) substituted "33 percent" for "50 percent" and in subcl. (II) substituted "67 percent" for "50 percent", "national limited monthly payment rate" for "regional monthly payment rate", and "subparagraph (B)(ii)" for "subpa… · (a)
• Pub. L. 101–508, §4152(b)(3)(C)(i), substituted "national limited monthly payment rate" for "regional monthly payment rate". · (a)
• Pub. L. 101–508, §4152(b)(3)(D), struck out subpar. (D) which read as follows: "The amount that is recognized under subparagraph (C) as the base monthly payment amount for an item furnished— · (a)
• Pub. L. 101–508, §4152(b)(5), struck out "defined for purposes of paragraphs (8)(B) and (9)(B)" after "one or more entire regions". · (a)
• Pub. L. 101–508, §4153(a)(2)(D)(iii), substituted "means durable medical equipment (as defined in section 1395x(n) of this title), including such equipment described in section 1395x(m)(5) of this title)." for "means— · (a)
• Pub. L. 101–508, §4152(b)(4), added par. (14). · (a)
• Pub. L. 101–508, §4152(e), added par. (15). · (a)
• Pub. L. 101–508, §4152(f)(1), added par. (16). · (a)
• Pub. L. 101–508, §4163(b)(1), inserted "and subject to subsection (c)(1)(A)" after "conversion factors". · (b)
• Pub. L. 101–508, §4102(f), inserted "locality," after "statewide,". · (b)
• Pub. L. 101–508, §4102(a)(2), added subpar. (D). Former subpar. (D) redesignated (E) relating to subsequent updating. · (b)
• Pub. L. 101–508, §4102(d), as amended by Pub. L. 103–432, §126(b)(4), added subpar. (E) relating to rule for certain scanning services. · (b)
• Pub. L. 101–508, §4102(a)(1), redesignated subpar. (D), relating to subsequent updating, as (E). Former subpar. (E) redesignated (F). · (b)
• Pub. L. 101–508, §4102(a)(1), redesignated subpar. (E) as (F). · (b)
• Pub. L. 101–508, §4163(b)(2), added subsec. (c). · (c)
• Pub. L. 101–508, §4104(a), amended subsec. (f) generally, substituting provisions relating to reduction in payments for physician pathology services during 1991 for provisions directing Secretary to provide for application of a fee schedule with respect to such services. · (f)
• Pub. L. 101–508, §4153(a)(1), added subsec. (h). · (h)

1989

• Pub. L. 101–239, §6112(c), added subpar. (D). · (a)
• Pub. L. 101–239, §6112(d)(1), added cl. (iii). · (a)
• Pub. L. 101–239, §6112(a)(1), inserted "and in 1990" after "1989". · (a), (3)
• Pub. L. 101–239, §6112(a)(4)(A), substituted "this clause" for "this subparagraph". · (a)
• Pub. L. 101–239, §6112(a)(4)(B), inserted "in" after "rental of the item". · (a)
• Pub. L. 101–239, §6112(a)(4)(C), substituted "clause (i) shall apply in the same manner as it applies to items furnished during 1989" for "the payment amount recognized under subparagraph (A)(i) shall not be more than the maximum amount established under clause (i), and shall… · (a)
• Pub. L. 101–239, §6112(a)(2)(A), inserted "and 1990" after "1989". · (a)
• Pub. L. 101–239, §6112(a)(2)(B), substituted "1991 or 1992" for "1990, 1991, or 1992". · (a)
• Pub. L. 101–239, §6140(1), substituted "1991, may not exceed 125 percent, and may not be lower than 85 percent" for "1991, may not exceed 130 percent, and may not be lower than 80 percent". · (a)
• Pub. L. 101–239, §6140(2), substituted "120 percent, and may not be lower than 90 percent" for "125 percent, and may not be lower than 85 percent". · (a)
• Pub. L. 101–239, §6112(a)(3)(A), inserted "and 1990" after "1989". · (a)
• Pub. L. 101–239, §6112(a)(3)(B), substituted "1991 and 1992" for "1990, 1991, and 1992". · (a)
• Pub. L. 101–239, §6140(1), substituted "1991, may not exceed 125 percent, and may not be lower than 85 percent" for "1991, may not exceed 130 percent, and may not be lower than 80 percent". · (a)
• Pub. L. 101–239, §6140(2), substituted "120 percent, and may not be lower than 90 percent" for "125 percent, and may not be lower than 85 percent". · (a)
• Pub. L. 101–239, §6112(e)(2), inserted before period at end "or medical supplies (including catheters, catheter supplies, ostomy bags, and supplies related to ostomy care) furnished by a home health agency under section 1395x(m)(5) of this title". · (a)
• Pub. L. 101–234, §201(a), repealed Pub. L. 100–360, §204(b)(1), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below. · (b)
• Pub. L. 101–234, §301(b)(1), (c)(1), amended subpar. (A) identically, substituting "coinsurance and deductibles under sections 1395l(a)(1)(J)" for "insurance and deductibles under section 1395n(a)(1)(I)". · (b)
• Pub. L. 101–239, §6105(a), added subpar. (C) and redesignated former subpars. (C) and (D) as (D) and (E), respectively. · (b)
• Pub. L. 101–234, §201(a), repealed Pub. L. 100–360, §§202(b)(4), 203(c)(1)(F), 204(b)(2), and provided that the provisions of law amended or repealed by such sections are restored or revived as if such sections had not been enacted, see 1988 Amendment notes below. · (c), (d), (e)
• Pub. L. 101–239, §6102(f)(1), added subsec. (f). · (f)
• Pub. L. 101–239, §6116(b)(2), added subsec. (g). · (g)

1988

• Pub. L. 100–360, §411(g)(1)(A), inserted "items and" in section catchline.
• Pub. L. 100–360, §411(g)(1)(B)(i), inserted "or under part A to a home health agency" before period at end. · (a)
• Pub. L. 100–360, §411(g)(1)(B)(iii), struck out "rental" before "payments" in concluding provisions. · (a)
• Pub. L. 100–360, §411(g)(1) (B)(iii), substituted "reasonable" for "allowed". · (a)
• Pub. L. 100–360, §411(g)(1)(B)(iv), struck out the extra space appearing in text of original act after "ventilators". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(iii), substituted "reasonable" for "allowable". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(v)–(vii), inserted ", and for that reason cannot be grouped with similar items for purposes of payment under this subchapter," after "individual patient", inserted cl. (A) and (B) designations, and in cl. (B), substituted "servicing" for "service" in … · (a)
• Pub. L. 100–360, §411(g)(1) (B)(vii), inserted "maintenance and" before "servicing". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(vii), (viii), substituted "maintenance and servicing" for "service and maintenance", and in subcl. (I) substituted "fee or fees established by the Secretary" for "fee established by the carrier". · (a)
• Pub. L. 100–360, §411(a)(3)(A), (C)(ii), provided that subsec. (a)(7)(B)(i) of this section, as inserted by section 4062(b) of Pub. L. 100–203, is deemed to have a reference to "1987" immediately after "December". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(iii), substituted "reasonable" for "allowable". · (a)
• Pub. L. 100–360, §411(g)(1)(B)(xi), as amended Pub. L. 100–485, §608(d)(22)(A)(i), substituted "(as defined by the Secretary)" for "(as defined in section 1395ww(d)(2)(D) of this title)", and in cl. (i) struck out the comma after "1991". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(ix), substituted "6-month" for "12-month". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(x), substituted ", 1991, and 1992" for "and to 1991". · (a)
• Pub. L. 100–360, §411(g)(1)(B)(xi), as amended by Pub. L. 100–485, §608(d)(22)(A)(i), substituted "(as defined by the Secretary)" for "(as defined in section 1395ww(d)(2)(D) of this title)", and in cl. (i) struck out the comma after "1991". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(xii), substituted "subparagraph (A)(ii)" for "subparagraph (A)(ii)(I)". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(xiii), inserted before period at end "and payments under this subsection as such provisions apply to physicians' services and physicians and a reasonable charge under section 1395u(b) of this title". · (a)
• Pub. L. 100–360, §411(g)(1) (B)(vii), (xiv), inserted "maintenance and" before "servicing" and substituted "section 1395u(j)(2) of this title" for "subsection (j)(2) of this section". · (a)
• Pub. L. 100–360, §411(g)(1)(B)(xv), as amended by Pub. L. 100–485, §608(d)(22)(A)(ii), substituted "one or more entire regions defined for purposes of paragraphs (8)(B) and (9)(B)" for "each region (as defined in section 1395ww(d)(2)(D) of this title)". · (a)
• Pub. L. 100–360, §411(g)(1)(B)(xvi), struck out par. (14) which read as follows: "In this subsection, any reference to the term 'carrier' includes a reference, with respect to durable medical equipment furnished by a home health agency as part of home health services, to a fiscal i… · (a)
• Pub. L. 100–360, §411(a)(3)(A), (B)(ii), (f)(8)(B)(ii), amended Pub. L. 100–203, §4049(a)(2), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §204(b)(1), inserted "and subject to subsection (e)(1)(A) of this section" after "conversion factors". · (b)
• Pub. L. 100–360, §411(f)(8)(D)(ii), as added by Pub. L. 100–485, §608(d)(21)(C), substituted "For radiologist" for "Radiologist" and "1395u(i)(3) of this title" for "1395u(b)(4)(E)(ii) of this title". · (b)
• Pub. L. 100–360, §411(f)(8)(D)(i), inserted "and suppliers" after "physicians" in heading. · (b), (5)
• Pub. L. 100–360, §411(f)(8)(D)(iii), (iv), formerly (ii), (iii), as redesignated by Pub. L. 100–485, §608(d)(21)(C), substituted "bills" for "imposes a charge" and inserted "in the same manner as such sanctions may apply to a physician" before period at end. · (b)
• Pub. L. 100–360, §411(f)(8)(D)(v), formerly (iv), as redesignated by Pub. L. 100–485, §608(d)(21)(C), substituted "and section 1395l(a)(1)(J) of this title" for ", section 1395l(a)(1)(I) of this title, and section 1395u(h)(1)(B) of this title". · (b)
• Pub. L. 100–360, §411(f)(8)(A), substituted "radiology" for "radiologic". · (b)
• Pub. L. 100–360, §411(f)(8)(D)(vi), formerly (v), as redesignated by Pub. L. 100–485, §608(d)(21)(C), substituted "the total amount of charges" for "billings". · (b)
• Pub. L. 100–360, §411(f)(8)(A), substituted "radiology" for "radiologic". · (b)
• Pub. L. 100–360, §202(b)(4), added subsec. (c) relating to payment for covered outpatient drugs. · (c)
• Pub. L. 100–360, §203(c)(1)(F), added subsec. (d) relating to home intravenous drug therapy services. · (d)
• Pub. L. 100–360, §204(b)(2), added subsec. (e) relating to payments and standards for screening mammography. · (e)

1987

• Pub. L. 100–203, §4049(a)(2), as amended by Pub. L. 100–360, §411(a)(3)(A), (B)(ii), (f)(8)(B)(ii), added subsec. (b). · (b)