42 U.S.C. 1395u: Provisions relating to the administration of part B

2022

• Pub. L. 117–328, §4121(a)(5), added cls. (vii) and (viii). (Consolidated Appropriations Act, 2023) Law text · (b), (viii)
• Pub. L. 117–328, §4134(b), added par. (8). (Consolidated Appropriations Act, 2023) Law text · (o)

2020

• Pub. L. 116–260 inserted "for such services furnished before January 1, 2022," after "section 1395x(s)(2)(K) of this title,". (Consolidated Appropriations Act, 2021) Law text · (b)

2018

• Pub. L. 115–123 inserted "or, in the case of items and services described in clause (i) of section 1395m(u)(7)(A) of this title furnished to an individual during the period described in clause (ii) of such section, payment shall be made to the eligible home infusion therapy suppl… (Bipartisan Budget Act of 2018) Law text · (b)

2016

• Pub. L. 114–255, §5012(c)(2), added subpar. (I). (21st Century Cures Act) Law text · (b)
• Pub. L. 114–255, §16006(a), added subpar. (J). (21st Century Cures Act) Law text · (b)
• Pub. L. 114–255, §5004(a)(1), inserted "(and including a drug or biological described in subparagraph (D)(i) furnished on or after January 1, 2017)" after "2005". (21st Century Cures Act) Law text · (o)
• Pub. L. 114–255, §5004(a)(2), substituted "infusion drugs or biologicals" for "infusion drugs" and "2004, and before January 1, 2017" for "2004" and struck out "for such drug" after "average wholesale price". (21st Century Cures Act) Law text · (o)
• Pub. L. 114–255, §5004(a)(2)(A), (b)(2), substituted "infusion drugs or biologicals" for "infusion drugs" and "2007, and before December 13, 2016." for "2007". (21st Century Cures Act) Law text · (o)
• Pub. L. 114–255, §16008(b)(2), substituted "subject to section 1395m(a)(1)(G) of this title, the Secretary" for "the Secretary". (21st Century Cures Act) Law text · (s)

2012

• Pub. L. 112–96 designated existing provisions as par. (1) and added par. (2). (Middle Class Tax Relief and Job Creation Act of 2012) Law text · (t)

2011

• Pub. L. 112–40 substituted "quality improvement organization" for "peer review organization". Law text · (l), (2)

2010

• Pub. L. 111–148, §6404(a)(2)(A)(ii), at end of concluding provisions, inserted "In applying subparagraph (B), the Secretary may specify exceptions to the 1 calendar year period specified in such subparagraph." (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–148, §6404(a)(2)(A)(i), substituted "period ending 1 calendar year after the date of service" for "close of the calendar year following the year in which such service is furnished (deeming any service furnished in the last 3 months of any calendar year to have been fu… (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–148, §6406(a), added par. (9). (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §3401(o), designated existing provisions as subpar. (A), added subpar. (B) and concluding provisions, and struck out former second sentence, which read as follows: "Any fee schedule established under this paragraph for such item or service shall be updated each year… (Patient Protection and Affordable Care Act) Law text · (s)

2008

• Pub. L. 110–275, §137, struck out "(before July 1, 2008)" after "or are provided". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (b)
• Pub. L. 110–275, §154(a)(2)(B), substituted "except that for items and services described in paragraph (2)(D)—" for "except that in no event shall a fee schedule for an item described in paragraph (2)(D) be updated before 2003." and added subpars. (A) and (B). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (s)

2007

• Pub. L. 110–173 substituted "July 1, 2008" for "January 1, 2008". (Medicare, Medicaid, and SCHIP Extension Act of 2007) Law text · (b)
• Pub. L. 110–54 inserted "or are provided (before January 1, 2008) over a longer continuous period during all of which the first physician has been called or ordered to active duty as a member of a reserve component of the Armed Forces" after "of more than 60 days". Law text · (b)

2006

• Pub. L. 109–432, §§205(b)(2), 405(c)(2)(A)(i), amended directory language of Pub. L. 109–171, §5114(a)(2), identically, making technical correction. See below. (Tax Relief and Health Care Act of 2006) Law text · (b)
• Pub. L. 109–171, §5114(a)(2), as amended by Pub. L. 109–432, §§205(b)(2), 405(c)(2)(A)(i), added subpar. (H). (Deficit Reduction Act of 2005) Law text · (b)
• Pub. L. 109–171, §5202(a)(2), substituted "28 days" for "26 days". (Deficit Reduction Act of 2005) Law text · (c)
• Pub. L. 109–432, §110(a), added subsec. (u). (Tax Relief and Health Care Act of 2006) Law text · (u)

2003

• Pub. L. 108–173, §911(c)(1), substituted "Provisions relating to the administration of part B" for "Use of carriers for administration of benefits" in section catchline. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text
• Pub. L. 108–173, §911(c)(2), amended subsec. (a) generally. Prior to amendment, subsec. (a) authorized the Secretary to enter into contracts with carriers for the administration of benefits under this part. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §911(c)(3)(A), struck out par. (1), which provided that contracts with carriers under subsection (a) could be entered into without regard to section 5 of title 41 or any other provision of law requiring competitive bidding. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(B)(i), struck out subpars. (A) and (B), which conditioned entering into contract on Secretary's finding that carrier would perform obligations efficiently and effectively, provided for establishment and publication of standards and criteria for ef… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b), (B)
• Pub. L. 108–173, §911(c)(3)(B)(ii), substituted "medicare administrative contractors" for "carriers". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(B)(iii), struck out subpars. (D) and (E), which directed that carrier be subject to standards and criteria relating to the carrier's success in recovering payments for items or services for which payment has been or could be made under a primary p… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b), (E)
• Pub. L. 108–173, §911(c)(3)(C)(ix), inserted "medicare administrative contractor," after "carrier," in seventh sentence in concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(viii), struck out "and shall contain such other terms and conditions not inconsistent with this section as the Secretary may find necessary or appropriate." before "In determining" in concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(i), substituted "The Secretary" for "Each such contract shall provide that the carrier" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(ii), substituted "shall take such action" for "will take such action". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(iii), substituted "to the policyholders and subscribers of the medicare administrative contractor" for "to the policyholders and subscribers of the carrier" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(ii), substituted "shall take such action" for "will take such action" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(iv), struck out subpars. (C) to (E), which directed that each contract provide that the carrier would establish and maintain procedures for a fair hearing in any case where the amount in controversy was between $100 and $500, that the carrier… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(ii), substituted "shall take such action" for "will take such action". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(ii), substituted "shall, for a service" for "will, for a service" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(v)(I), struck out "if it makes determinations or payments with respect to physicians' services," before "shall implement" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(ii), substituted "shall implement" for "will implement" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(v)(II), substituted "medicare administrative contractor" for "carrier". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(vi), struck out subpar. (I), which directed that each contract would require the carrier to submit annual reports to the Secretary describing steps taken to recover payments made under this part for items or services for which payment had been or co… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(vii), substituted period for semicolon at end. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(C)(ii), substituted "shall monitor" for "will monitor". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(D), struck out par. (5), which provided that each contract under this section would be for a term of at least one year and could be made automatically renewable and authorized Secretary to terminate any contract where carrier had failed substantially to c… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §952(b), substituted "except to an employer or entity as described in subparagraph (A)" for "except to an employer or facility as described in clause (A)" in second sentence. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §952(a), added cl. (ii) and struck out former cl. (ii) which read as follows: "(where the service was provided in a hospital, critical access hospital, clinic, or other facility) to the facility in which the service was provided if there is a contractual arra… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(E), substituted "medicare administrative contractor" for "carrier". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(3)(F), substituted "the Secretary" for "the carrier" in introductory provisions of subpar. (A), before "shall take into account" in subpar. (B)(i), in introductory provisions of subpar. (B)(ii), and before "shall provide" in subpar. (C). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §911(c)(4)(A), struck out par. (1), which provided that any contract entered into with a carrier under this section would provide for advances of funds for the making of payments and for payment for necessary and proper cost of administration, and directed the Secre… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §911(c)(4)(B), substituted "contract under section 1395kk–1 of this title that provides for making payments under this part" for "contract under this section which provides for the disbursement of funds, as described in subsection (a)(1)(B) of this section," in i… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §736(b)(8)(A), struck out "and" at end. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §736(b)(8)(B), substituted ", and" for period at end. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §911(c)(4)(C), substituted "section 1395kk–1(a)(3)(B) of this title" for "subsection (a)(1)(B) of this section". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §911(c)(4)(D), substituted "medicare administrative contractor" for "carrier" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §911(c)(4)(E), struck out pars. (5) and (6), which provided that each contract would require the carrier to meet criteria to measure the timeliness of responses to requests for payment of items described in section 1395m(a)(15)(C) of this title and prohibited a… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c), (6)
• Pub. L. 108–173, §911(c)(5), struck out subsecs. (d) to (f), which provided that contracts under this section could require surety bonds and that certifying or disbursing officers or carriers would not be liable with respect to payments in the absence of gross negligence or int… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d), (e), (f)
• Pub. L. 108–173, §911(c)(6), substituted "medicare administrative contractor or contractors" for "carrier or carriers". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (g)
• Pub. L. 108–173, §911(c)(7)(A), substituted "The Secretary" for "Each carrier having an agreement with the Secretary under subsection (a) of this section" in first sentence and for "Each such carrier" in last sentence. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §911(c)(7)(B)(ii), which directed substitution of "such contractor" for "such carrier", was executed by making the substitution in two places to reflect the probable intent of Congress. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §911(c)(7)(B)(i), substituted "medicare administrative contractor having a contract under section 1395kk–1 of this title that provides for making payments under this part" for "a carrier having an agreement with the Secretary under subsection (a) of this section". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §911(c)(7)(C), substituted "a medicare administrative contractor" for "a carrier" in two places and "the contractor" for "the carrier" in two places. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h)
• Pub. L. 108–173, §911(c)(7)(D), substituted "medicare administrative contractors" for "carriers". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (h), (B)
• Pub. L. 108–173, §736(b)(9), substituted "services, to a physician" for "services, a physician". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (i)
• Pub. L. 108–173, §911(c)(8), substituted "medicare administrative contractor" for "carrier". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l), (2)
• Pub. L. 108–173, §303(b)(1), substituted "equal to the following:" for "equal to 95 percent of the average wholesale price." and added subpars. (A) to (G). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (o)
• Pub. L. 108–173, §305(a), amended subpar. (G) generally. Prior to amendment, subpar. (G) read as follows: "The provisions of subparagraphs (A) through (F) of this paragraph shall not apply to an inhalation drug or biological furnished through durable medical equipment covered und… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (o)
• Pub. L. 108–173, §303(i)(1), inserted at end "This paragraph shall not apply in the case of payment under paragraph (1)(C)." (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (o)
• Pub. L. 108–173, §303(b)(2), added par. (4). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (o)
• Pub. L. 108–173, §303(e), added pars. (5) and (6). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (o), (6)
• Pub. L. 108–173, §303(g)(1), added par. (7). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (o)
• Pub. L. 108–173, §911(c)(9), substituted "medicare administrative contractor" for "carrier". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (p)
• Pub. L. 108–173, §911(c)(10), struck out "carrier" before "localities". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (q)
• Pub. L. 108–173, §302(d)(3)(A), substituted "Subject to paragraph (3), the Secretary" for "The Secretary". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (s)
• Pub. L. 108–173, §627(b)(2), struck out subpar. (C) which read as follows: "Therapeutic shoes." (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (s)
• Pub. L. 108–173, §302(d)(3)(B), added par. (3). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (s)

2000

• Pub. L. 106–554, §1(a)(6) [title II, §222(a)], struck out "for such services provided before January 1, 2003," before "payment may be made" and substituted comma for semicolon at end. (Consolidated Appropriations Act, 2001) Law text · (b)
• Pub. L. 106–554, §1(a)(6) [title III, §313(b)(1)], inserted "by, or under arrangements made by, a skilled nursing facility" before "to an individual who" and struck out "or of a part of a facility that includes a skilled nursing facility (as determined under regulations)" before … (Consolidated Appropriations Act, 2001) Law text · (b)
• Pub. L. 106–554, §1(a)(6) [title IV, §432(b)(2)], added subpar. (G). (Consolidated Appropriations Act, 2001) Law text · (b)
• Pub. L. 106–554, §1(a)(6) [title I, §105(d)], added cl. (vi). (Consolidated Appropriations Act, 2001) Law text · (b)
• Pub. L. 106–554, §1(a)(6) [title I, §114(a)], added par. (3). (Consolidated Appropriations Act, 2001) Law text · (o)
• Pub. L. 106–554, §1(a)(6) [title III, §313(b)(2)], struck out "by a physician" before "to an individual" and "or of a part of a facility that includes a skilled nursing facility (as determined under regulations)," before "for which payment may be made". (Consolidated Appropriations Act, 2001) Law text · (t)

1999

• Pub. L. 106–113, §1000(a)(6) [title III, §305(a)], inserted "(including medical supplies described in section 1395x(m)(5) of this title, but excluding durable medical equipment to the extent provided for in such section)" after "home health services". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (b)
• Pub. L. 106–113, §1000(a)(6) [title II, §223(c)], substituted "the application of this subchapter to payment under this part" for "the application of this part". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (b)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(4)], inserted period at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (s)

1997

• Pub. L. 105–33, §4611(d), added subpar. (E). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4512(c), inserted at end "For purposes of subparagraph (C) of the first sentence of this paragraph, an employment relationship may include any independent contractor arrangement, and employer status shall be determined in accordance with the law of the State in whic… (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4201(c)(1), substituted "critical access" for "rural primary care". (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4205(d)(3)(B), amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: "in the case of services described in clauses (i), (ii), or (iv) of section 1395x(s)(2)(K) of this title payment shall be made to the employer of the physician assistan… (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4432(b)(2), added subpar. (E). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4603(c)(2)(B)(i), added subpar. (F). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4316(a), amended pars. (8) and (9) generally. Prior to amendment, par. (8) related to determination of reasonable charges for physician services, including factors to be considered, provision for increase or decrease of charge, consideration of resource costs, … (Balanced Budget Act of 1997) Law text · (b), (9)
• Pub. L. 105–33, §4512(b)(2), struck out par. (12) which read as follows: (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4531(a)(2), added par. (19). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4302(b), added par. (8). (Balanced Budget Act of 1997) Law text · (h)
• Pub. L. 105–33, §4556(a), added subsec. (o). (Balanced Budget Act of 1997) Law text · (o)
• Pub. L. 105–33, §4317(a), inserted "or practitioner specified in subsection (b)(18)(C)" after "by a physician". (Balanced Budget Act of 1997) Law text · (p), (2)
• Pub. L. 105–33, §4317(b), added par. (4). (Balanced Budget Act of 1997) Law text · (p)
• Pub. L. 105–33, §4315(a), added subsec. (s). (Balanced Budget Act of 1997) Law text · (s)
• Pub. L. 105–33, §4432(b)(4), added subsec. (t). (Balanced Budget Act of 1997) Law text · (t)

1996

• Pub. L. 104–191, §202(b)(2), added par. (6). (Health Insurance Portability and Accountability Act of 1996) Law text · (c)
• Pub. L. 104–191, §221(b), inserted at end "Under such system, the Secretary may impose appropriate fees on such physicians to cover the costs of investigation and recertification activities with respect to the issuance of the identifiers." (Health Insurance Portability and Accountability Act of 1996) Law text · (r)

1994

• Pub. L. 103–432, §126(g)(9), made technical amendment to directory language of Pub. L. 101–508, §4118(j)(2). See 1990 Amendment note below. · (b)
• Pub. L. 103–432, §151(b)(2)(B), added subpar. (D). · (b)
• Pub. L. 103–432, §151(b)(1)(B)(i), which directed striking out "and" at end of subpar. (G), could not be executed because "and" did not appear at end of subpar. (G) subsequent to amendment by Pub. L. 103–432, §123(c)(2). See below. · (b)
• Pub. L. 103–432, §123(c)(2), amended subpar. (G) generally. Prior to amendment, subpar. (G) read as follows: "will provide to each nonparticipating physician, at the beginning of each year, a list of the physician's limiting charges established under section 1395w–4(g)(2) of this title for the year… · (b)
• Pub. L. 103–432, §151(b)(1)(B)(ii), which directed striking out "and" at end of subpar. (H), could not be executed because "and" does not appear at end. · (b)
• Pub. L. 103–432, §151(b)(1)(B)(iii), added subpar. (I). · (b)
• Pub. L. 103–432, §125(b)(1), amended subpar. (D) generally. Prior to amendment, subpar. (D) read as follows: "payment may be made to a physician who arranges for visit services (including emergency visits and related services) to be provided to an individual by a second physician… · (b)
• Pub. L. 103–432, §123(b)(2)(B), struck out subpar. (C). Prior to amendment, subpar. (C) read as follows: "Except for deductible and coinsurance amounts applicable under section 1395l of this title, any person who knowingly and willfully presents, or causes to be presented, to an… · (b)
• Pub. L. 103–432, §126(a)(1), struck out ", simple and subcutaneous" after "Partial", substituted "injections and small joint" for "injections; small joint" and "femoral fracture and" for "femoral fracture treatments;", struck out "lobectomy;" after "thoracostomy;" and "ente… · (b)
• Pub. L. 103–432, §126(e), redesignated par. (18), relating to payment for technical component of diagnostic tests, as (17) and inserted ", tests specified in paragraph (14)(C)(i)," after "diagnostic laboratory tests". · (b)
• Pub. L. 103–432, §126(e), redesignated par. (18), relating to payment for technical component of diagnostic tests, as (17). · (b)
• Pub. L. 103–432, §123(b)(1), added par. (18), relating to payment for service furnished by a practitioner described in subpar. (C). · (b)
• Pub. L. 103–432, §126(h)(2), struck out subpar. (A) designation before "Any contract entered" and struck out subpar. (B) which read as follows: "Of the amounts appropriated for administrative activities to carry out this part, the Secretary shall provide payments, totaling 1 percent… · (c)
• Pub. L. 103–432, §125(a), added par. (4). · (c)
• Pub. L. 103–432, §135(b)(2), added par. (5). · (c)
• Pub. L. 103–432, §123(c)(1)(B), struck out "shall include" before cl. (i). · (h)
• Pub. L. 103–432, §123(c)(1)(A), (C), (D), added subpar. (D). · (h)
• Pub. L. 103–432, §126(c)(1), made technical amendment to Pub. L. 101–508, §4103(a). See 1990 Amendment note below. · (q)
• Pub. L. 103–432, §126(c)(2)(A), substituted "shall, subject to clause (iv), be reduced to the adjusted prevailing charge conversion factor for the locality determined as follows:" for "shall be determined as follows:" in introductory provisions. · (q)
• Pub. L. 103–432, §126(c)(2)(B), substituted "The adjusted prevailing charge conversion factor for" for "Subject to clause (iv), the prevailing charge conversion factor to be applied in". · (q)

1993

• Pub. L. 103–66, §13515(a)(2), struck out subpar. (F) which related to prevailing charge or fee schedule amount in case of professional services of health care practitioner (other than primary care services and other than services furnished in rural area designated as health profe… · (b)
• Pub. L. 103–66, §13516(a)(2)(A), added subpar. (A) and struck out former subpar. (A) which read as follows: "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… · (b)
• Pub. L. 103–66, §13516(a)(2), redesignated subpar. (C) as (B), substituted "subparagraph (A)" for "subparagraph (A) or (B)", and struck out former subpar. (B) which read as follows: "In determining the reasonable charge under paragraph (3) of a physician for medical directi… · (b), (C)
• Pub. L. 103–66, §13568(b), substituted "period ending on or before September 30, 1993" for "period" in subcl. (IV) and added subcl. (V). · (c)
• Pub. L. 103–66, §13568(a), added cls. (i) and (ii) and struck out former cls. (i) and (ii) which read as follows: · (c)
• Pub. L. 103–66, §13517(b), substituted "; the term" for ", and the term" and inserted before period at end "; and the term 'nonparticipating supplier or other person' means a supplier or other person (excluding a provider of services) that is not a participating physician or supplie… · (i)

1990

• Pub. L. 101–508, §4118(j)(2), as amended by Pub. L. 103–432, §126(g)(9), substituted "section 1395w–1(e)(2)" for "section 1395w–1(f)(2)". · (b)
• Pub. L. 101–508, §4118(f)(2)(B), substituted "section 1395w–4(g)(2) of this title" for "subsection (j)(1)(C) of this section". · (b)
• Pub. L. 101–508, §4105(b)(1), substituted "60 percent" for "50 percent". · (b)
• Pub. L. 101–508, §4105(a)(2), added cl. (iv). · (b)
• Pub. L. 101–508, §4118(a)(2), substituted "the list referred to in paragraph (14)(C)(i)" for "Table #2 in the Joint Explanatory Statement of the Committee of Conference submitted with the Conference Report to accompany H.R. 3299 (the 'Omnibus Budget Reconciliation Act of 1… · (b)
• Pub. L. 101–508, §4105(a)(1), added cl. (v). · (b)
• Pub. L. 101–508, §4106(a)(1), amended subpar. (F) generally. Prior to amendment, subpar. (F) read as follows: "In determining the customary charges for physicians' services furnished during a calendar year (other than primary care services and other than services furnished in a r… · (b)
• Pub. L. 101–597 substituted "health professional shortage area" for "health manpower shortage area". · (b)
• Pub. L. 101–508, §4106(b)(2)(A), (B), substituted "professional services" for "physicians' services and professional services" and "practitioner's first" for "physician's or practitioner's first". · (b)
• Pub. L. 101–508, §4106(b)(2)(C), substituted "practitioner" for "physician or practitioner" in two places. · (b)
• Pub. L. 101–508, §4155(c), substituted "clauses (i), (ii), or (iv) of section 1395x(s)(2)(K)" for "section 1395x(s)(2)(K)". · (b)
• Pub. L. 101–508, §4110(a), added subpar. (D). · (b)
• Pub. L. 101–508, §4155(c), substituted "clauses (i), (ii), or (iv) of section 1395x(s)(2)(K)" for "section 1395x(s)(2)(K)" in introductory provisions. · (b)
• Pub. L. 101–508, §4118(f)(2)(C), struck out ", as the case may be" after "section 1395w–4 of this title". · (b)
• Pub. L. 101–508, §4118(f)(2)(A), made technical correction to Pub. L. 101–239, §6102(e)(4). See 1989 Amendment note below. · (b)
• Pub. L. 101–508, §4155(c), substituted "clauses (i), (ii), or (iv) of section 1395x(s)(2)(K)" for "section 1395x(s)(2)(K)". · (b)
• Pub. L. 101–508, §4103(b), substituted "1996" for "1991". · (b), (B)
• Pub. L. 101–508, §4101(a), designated existing provisions as cl. (i) and added cl. (ii). · (b)
• Pub. L. 101–508, §4118(a)(1)(A), which directed amendment of subcl. (I) by substituting "practice expense component (percent), divided by 100, specified in appendix A (pages 187 through 194) of the Report of the Medicare and Medicaid Health Budget Reconciliation Amendmen… · (b)
• Pub. L. 101–508, §4118(a)(1)(B), substituted "practice expense component (percent), divided by 100" for "practice expense ratio". · (b)
• Pub. L. 101–508, §4118(a)(1)(C), substituted "procedures specified (by code and description) in the Overvalued Procedures List for Finance Committee, Revised September 20, 1989, prepared by the Physician Payment Review Commission" for "physicians' services specified in Table … · (b)
• Pub. L. 101–508, §4118(a)(1)(D), which directed amendment of cl. (iii) by substituting "The 'percentage change' specified in this clause, for a physicians' service specified in clause (i), is the percent difference (but expressed as a positive number) specified for the serv… · (b)
• Pub. L. 101–508, §4118(a)(1)(E), which directed amendment of cl. (iv) by substituting "the Geographic Overhead Costs Index specified for the locality in table 1 of the September 1989 Supplement to the Geographic Medicare Economic Index: Alternative Approaches (prepared by th… · (b)
• Pub. L. 101–508, §4101(b), added par. (16). · (b)
• Pub. L. 101–508, §4108(a), added par. (18). · (b)
• Pub. L. 101–508, §4103(a), as amended by Pub. L. 103–432, §126(c)(1), designated existing provisions as subpar. (A) and added subpar. (B). · (q)
• Pub. L. 101–508, §4118(i)(1), added subsec. (r). · (r)

1989

• Pub. L. 101–239, §6202(d)(2), inserted at end "The Secretary may not require, as a condition of entering into or renewing a contract under this section or under section 1395hh of this title, that a carrier match data obtained other than in its activities under this part with data… · (b)
• Pub. L. 101–234, §201(a), repealed Pub. L. 100–360, §202(e)(3)(C), 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. 101–239, §6114(c)(2), added subpar. (C). · (b)
• Pub. L. 101–239, §6102(e)(2), substituted "limiting charges established under subsection (j)(1)(C) of this section" for "maximum allowable actual charges (established under subsection (j)(1)(C) of this section)". · (b)
• Pub. L. 101–234, §201(a), repealed Pub. L. 100–360, §§201(c), 202(e)(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. · (b)
• Pub. L. 101–239, §6102(b), added subpar. (L). · (b)
• Pub. L. 101–239, §6102(e)(3), inserted "and before January 1, 1992," after "January 1, 1987,". · (b)
• Pub. L. 101–239, §6107(b), added cl. (iv). · (b)
• Pub. L. 101–239, §6108(a)(1), inserted "furnished during a calendar year" after "physicians' services" and inserted at end "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… · (b)
• Pub. L. 101–239, §6003(g)(3)(D)(ix), inserted "rural primary care hospital," after "hospital,". · (b)
• Pub. L. 101–239, §6114(c)(1), inserted "or nurse practitioner" after "physician assistant". · (b)
• Pub. L. 101–239, §6114(b), substituted "physician assistants and nurse practitioners" for "physician assistant acting under the supervision of a physician" in introductory provisions. · (b)
• Pub. L. 101–239, §6102(e)(4), as amended by Pub. L. 101–508, §4118(f)(2)(A), inserted "(or, for services furnished on or after January 1, 1992, the fee schedule amount specified in section 1395w–4 of this title, as the case may be)" after "prevailing charge rate determin… · (b)
• Pub. L. 101–239, §6104(a), added par. (14). · (b)
• Pub. L. 101–239, §6108(b)(1), added par. (15). · (b)
• Pub. L. 101–234, §201(a), repealed Pub. L. 100–360, §202(c)(1)(A), (B), (e)(1), (3)(A), (4)(A), (5), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been… · (c), (2), (3), (4), (f), (h)
• Pub. L. 101–239, §6102(e)(9), substituted "December 31, 1990." for "the earlier of (I) December 31, 1990, or (II) one-year after the date the Secretary reports to Congress, under section 1395w–1(e)(3) of this title, on the development of the relative value scale under section… · (j)
• Pub. L. 101–234, §301(b)(2), (c)(2), amended cl. (vii) identically, substituting "according" for "accordingly". · (j)
• Pub. L. 101–239, §6104(b)(1), inserted "or (b)(14)(A)" after "(b)(10)(A)". · (j)
• Pub. L. 101–239, §6108(b)(2)(A), inserted "or (b)(15)(A)" after "subsection (b)(11)(C)(i)". · (j)
• Pub. L. 101–239, §6108(b)(2)(B), substituted "(b)(14)(A), or (b)(15)(A)" for "or (b)(14)(A)". · (j)
• Pub. L. 101–239, §6104(b)(2), substituted "(b)(11)(C)(i), or (b)(14)(A)" for "or (b)(11)(C)(i)". · (j)
• Pub. L. 101–239, §6102(e)(9), substituted "December 31, 1990." for "the earlier of (I) December 31, 1990, or (II) one-year after the date the Secretary reports to Congress, under section 1395w–1(e)(3) of this title, on the development of the relative value scale under section … · (j)
• Pub. L. 101–234, §301(b)(6), (d)(3), which directed identical amendments to subsec. (j)(2) by substituting "subsections" for "paragraphs" in subpar. (B) as amended by section 8(c)(2)(A) of the Medicare and Medicaid Fraud and Abuse Patient Protection Act of 1987 [probably meaning sec… · (j)
• Pub. L. 101–234, §201(a), repealed Pub. L. 100–360, §202(c)(1)(C), 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. · (o)
• Pub. L. 101–239, §6106(a), added subsec. (q). · (q)

1988

• Pub. L. 100–360, §411(i)(2), amended Pub. L. 100–203, §4082(c), see 1987 Amendment note below. · (b)
• Pub. L. 100–485, §608(d)(5)(G), inserted ", including claims processing functions" after "and related functions" in last sentence. · (b)
• Pub. L. 100–360, §411(f)(1)(B), inserted reference to section 1395w–1(f)(2) of this title in third sentence. · (b)
• Pub. L. 100–360, §202(e)(3)(C), as amended by Pub. L. 100–485, §608(d)(5)(F), inserted at end "With respect to activities relating to implementation and operation (and related functions) of the electronic system established under subsection (o)(4) of this section, the Secretary may enter into contr… · (b)
• Pub. L. 100–360, §411(i)(4)(C)(vi), added Pub. L. 100–203, §4085(i)(24), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(4)(B)(ii), added Pub. L. 100–203, §4045(c)(2)(D), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(11)(A), (14), renumbered and amended Pub. L. 100–203, §4053(a), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(j)(4)(A), made technical correction to directory language of Pub. L. 100–203, §4096(a)(1)(A), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §201(c), added subpar. (I) requiring notice that an individual has reached the part B catastrophic limit on out-of-pocket cost sharing for the year. · (b)
• Pub. L. 100–360, §202(e)(2), added subpar. (J) relating to requirements for determinations or payments with respect to covered outpatient drugs, to receive information and respond to requests by participating pharmacies. · (b)
• Pub. L. 100–485, §608(d)(5)(C), inserted ", including claims processing functions," after "and for related functions". · (b)
• Pub. L. 100–360, §202(e)(2), added subpar. (K) requiring contracts with organizations described in subsection (f)(3) of this section to implement and operate the electronic system established under subsection (o)(4) of this section for covered outpatient drugs. · (b)
• Pub. L. 100–360, §411(f)(2)(F)(i), as amended by Pub. L. 100–485, §608(d)(21)(B), redesignated and amended Pub. L. 100–203, §4042(c)(1), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(2)(E), substituted "before January 1, 1989" for "before January 1, 1988". · (b)
• Pub. L. 100–360, §411(f)(3)(A), made technical amendment to directory language of Pub. L. 100–203, §4044(a), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(3)(B), substituted "subsection (i)(4)" for "subparagraph (E)(iii)" and "the estimated average prevailing charge levels based on the best available data" for "the average of the prevailing charge levels" and struck out "for participating physicians" before "under the third". · (b)
• Pub. L. 100–360, §411(f)(2)(D), added Pub. L. 100–203, §4042(b)(2)(A), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(3)(A), made technical amendment to directory language of Pub. L. 100–203, §4044(a), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(C), (D), see 1987 Amendment notes below. · (b)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(D), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(2)(B), substituted "subsection (i)(4)" for "subparagraph (E)(iii)". · (b)
• Pub. L. 100–360, §411(f)(2)(A), substituted "services," for "services;" in subcl. (I) and "physicians' " for "physician's" in subcl. (II). · (b)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(D), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(6)(B), substituted "other than primary care services" for "other primary care services" and struck out "(as determined under the third and fourth sentences of paragraph (3) and under paragraph (4))" after "the prevailing charge". · (b)
• Pub. L. 100–360, §411(i)(4)(C)(vi), added Pub. L. 100–203, §4085(i)(22)(C), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(4)(A)(i), struck out "under paragraph (3)" after "reasonable charge", substituted "subparagraph (B)" for "subparagraph (C)", and struck out "for participating and nonparticipating physicians" after "charge for such procedure". · (b)
• Pub. L. 100–360, §411(f)(4)(A)(ii), substituted "clause (i)(I)" for "clause (i)(II)". · (b)
• Pub. L. 100–360, §411(f)(4)(A)(iii), inserted "(including subsequent insertion of an intraocular lens)" after "cataract surgery". · (b)
• Pub. L. 100–360, §411(f)(4)(A)(iv), substituted "under section 1395ff" for "section 1395ff". · (b)
• Pub. L. 100–360, §411(f)(4)(B)(i), amended Pub. L. 100–203, §4045(c)(2)(B), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(5)(A), substituted "insertion" for "implantation". · (b)
• Pub. L. 100–360, §411(g)(2)(A), substituted "inserted during or subsequent to" for "implanted during". · (b)
• Pub. L. 100–360, §411(i)(4)(C)(vi), added Pub. L. 100–203, §4085(i)(25), see 1987 Amendment note below. · (b)
• Pub. L. 100–360, §411(f)(7)(A), redesignated par. (14) as (13). · (b), (14)
• Pub. L. 100–360, §202(e)(3)(A), designated existing provisions as cl. (i), inserted ", except as provided in clause (ii)," after "under this part, and" and added cl. (ii) relating to payment for implementation and operation of the electronic system for covered outpatient drugs. · (c)
• Pub. L. 100–485, §608(d)(5)(D), inserted ", including claims processing functions" after "and related functions". · (c)
• Pub. L. 100–360, §202(e)(5)(A), as amended by Pub. L. 100–485, §608(d)(5)(H), substituted "Except as provided in paragraph (4), each" for "Each". · (c), (3)
• Pub. L. 100–360, §202(e)(5)(B), added par. (4) requiring contracts for the disbursement of funds with respect to claims for payment for covered outpatient drugs to provide for a payment cycle, and requiring interest if such requirements are not met. · (c)
• Pub. L. 100–485, §608(d)(5)(B), inserted ", including claims processing functions" after "and related functions". · (f)
• Pub. L. 100–360, §202(e)(1), added par. (3) which read as follows: "with respect to implementation and operation (and related functions) of the electronic system established under subsection (o)(4) of this section, a voluntary association, corporation, partnership, or other nongovernmental organiza… · (f)
• Pub. L. 100–360, §202(c)(1)(A), inserted ", except that, with respect to a supplier of covered outpatient drugs, the term 'participating supplier' means a participating pharmacy (as defined in subsection (o)(1) of this section)" after "part during such year". · (h)
• Pub. L. 100–360, §202(e)(4)(A), inserted "(other than a carrier described in subsection (f)(3) of this section)" after "Each carrier". · (h)
• Pub. L. 100–360, §411(i)(1)(A), substituted "payment determination" for "claims determination", "shall include an explanation of benefits and any additional information that the Secretary may determine to be appropriate in order" for "including such information as the Secretary d… · (h)
• Pub. L. 100–360, §202(c)(1)(B), inserted at end "In publishing directories under this paragraph, the Secretary shall provide for separate directories (wherever appropriate) for participating pharmacies." · (h)
• Pub. L. 100–360, §223(b), designated existing provisions as subpar. (A), inserted "through an annual mailing", struck out at end "The Secretary shall include such notice in the mailing of appropriate benefit checks provided under subchapter II of this chapter.", and added subpar. (B… · (h)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(A), see 1987 Amendment note below. · (h)
• Pub. L. 100–360, §223(c), in subpar. (A) inserted "prominent" before "reminder" and substituted "and a clear statement of any amounts charged for the particular items or services on the claim involved above the amount recognized under this part)," for "7E), and" and added subpar. (C). · (h)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(B), see 1987 Amendment note below. · (h)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(B), see 1987 Amendment note below. · (i)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(C), see 1987 Amendment note below. · (i), (3)
• Pub. L. 100–485, §608(d)(21)(A), substituted "subsection (b)(3)" for "paragraph (3)". · (i)
• Pub. L. 100–360, §411(f)(2)(C), added Pub. L. 100–203, §4042(b)(1)(E), see 1987 Amendment note below. · (i)
• Pub. L. 100–360, §411(f)(2)(F)(ii), added Pub. L. 100–203, §4042(c)(2), see 1987 Amendment note below. · (j)
• Pub. L. 100–360, §411(f)(1)(A), amended Pub. L. 100–203, §4041(a)(1)(B), see 1987 Amendment note below. · (j)
• Pub. L. 100–360, §411(f)(7)(B), added Pub. L. 100–203, §4048(e), see 1987 Amendment note below. · (j)
• Pub. L. 100–360, §411(f)(5)(B), struck out "is" after "limit". · (j)
• Pub. L. 100–360, §411(g)(2)(B), redesignated subcl. (IV) as (V) and struck out "is" after "limit". · (j)
• Pub. L. 100–360, §411(g)(2)(C), amended Pub. L. 100–203, §4063(a)(2)(B), see 1987 Amendment note below. · (j)
• Pub. L. 100–360, §411(f)(4)(C), substituted "bills" for "imposes a charge". · (j)
• Pub. L. 100–360, §411(i)(4)(C)(vi), as amended by Pub. L. 100–485, §608(d)(24)(B), added Pub. L. 100–203, §4085(i)(26), see 1987 Amendment note below. · (j)
• Pub. L. 100–360, §411(i)(4)(C)(vi), added Pub. L. 100–203, §4085(i)(27), see 1987 Amendment note below. · (l)
• Pub. L. 100–360, §411(f)(9)(A), in introductory provisions, struck out "to a patient" after "includes a charge", inserted "the bill or request for" after "for which", and substituted "shares a practice" for "shares his practice" and "supervised the performance of the test, the" for … · (n)
• Pub. L. 100–485, §608(d)(17), substituted "the supplier's" for "the the supplier's". · (n)
• Pub. L. 100–360, §411(f)(9)(B), as amended by Pub. L. 100–485, §608(d)(21)(D), substituted "(or other applicable limit)" for "to individuals enrolled under this part". · (n)
• Pub. L. 100–360, §411(a)(3)(A), (C)(i), clarified that illegible matter after "or, if lower, the" was "the supplier's reasonable charge to individuals enrolled under this part for the test". · (n)
• Pub. L. 100–360, §411(f)(9)(C), inserted "the payment amount specified in paragraph (1)(A) and" after "other than". · (n)
• Pub. L. 100–360, §411(f)(9)(D), struck out "or supplier" after "such physician". · (n)
• Pub. L. 100–360, §202(c)(1)(C), added subsec. (o) relating to "participating pharmacies" as entities authorized under State law to dispense covered outpatient drugs which had entered into agreements with Secretary to participate in catastrophic coverage program. · (o)
• Pub. L. 100–485, §608(d)(5)(A)(i), substituted "paragraph (4)" for "subparagraph (D)(i)". · (o)
• Pub. L. 100–485, §608(d)(5)(A)(ii), substituted "an eligible organization" for "eligible organization". · (o)
• Pub. L. 100–360, §202(g), added subsec. (p). · (p)

1987

• Pub. L. 100–203, §4082(c), as amended by Pub. L. 100–360, §411(i)(2), designated existing provisions as subpar. (A) and added subpar. (B). · (b)
• Pub. L. 100–203, §4041(a)(3)(A)(i), inserted at end "In establishing such standards and criteria, the Secretary shall provide a system to measure a carrier's performance of responsibilities described in paragraph (3)(H) and subsection (h) of this section." · (b)
• Pub. L. 100–203, §4085(i)(24), as added by Pub. L. 100–360, §411(i)(4)(C)(vi), substituted "In the case of physicians' services" for "In the case of physician services" and "(with respect to physicians' services" for "(with respect to physicians services" in fourth sentence. · (b)
• Pub. L. 100–203, §4045(c)(2)(D), as added by Pub. L. 100–360, §411(f)(4)(B)(ii), inserted "(or under any other provision of law affecting the prevailing charge level)" in fourth sentence. · (b)
• Pub. L. 100–203, §4053(a), formerly §4052(a), as renumbered and amended by Pub. L. 100–360, §411(f)(11)(A), (14), inserted ", and shall remain at such prevailing charge level until the prevailing charge for a year (as adjusted by economic index data) equals or exceeds such prevailing charge level" … · (b)
• Pub. L. 100–203, §4096(a)(1)(A), as amended by Pub. L. 100–360, §411(j)(4)(A), added subcl. (II), redesignated former subcl. (II) as (III), and inserted "(and to refund amounts already collected)". · (b)
• Pub. L. 100–203, §4085(i)(5), substituted "less than $500" for "not more than $500". · (b)
• Pub. L. 100–203, §4042(c)(1), formerly §4042(c), as redesignated and amended by Pub. L. 100–360, §411(f)(2)(F)(i), and by Pub. L. 100–485, §608(d)(21)(B), amended cl. (iv) generally. Prior to amendment, cl. (iv) read as follows: "In determining the prevailing charge level und… · (b)
• Pub. L. 100–203, §4041(a)(1)(A)(i), added cl. (v). Former cl. (v) redesignated (vi). · (b)
• Pub. L. 100–203, §4044(a), as amended by Pub. L. 100–360, §411(f)(3)(A), added cl. (vi). Former cl. (vi) redesignated (vii). · (b)
• Pub. L. 100–203, §4041(a)(1)(A)(i), redesignated former cl. (v) as (vi). · (b)
• Pub. L. 100–203, §4042(b)(2)(A), as added by Pub. L. 100–360, §411(f)(2)(D), substituted "subsection (i)(3)" for "subparagraph (E)(ii)". · (b)
• Pub. L. 100–203, §4044(a), as amended by Pub. L. 100–360, §411(f)(3)(A), redesignated former cl. (vi) as (vii). · (b)
• Pub. L. 100–203, §4041(a)(1)(A)(ii), added cl. (iii). · (b)
• Pub. L. 100–203, §4042(b)(1)(D), as added by Pub. L. 100–360, §411(f)(2)(C), redesignated subpar. (F) as (E). Former subpar. (E) transferred to subsec. (i). · (b)
• Pub. L. 100–203, §4042(b)(1)(C), as added by Pub. L. 100–360, §411(f)(2)(C), struck out "(E) In this section:" before cl. (i), redesignated cls. (i) and (ii) as pars. (2) and (3), respectively, and transferred those pars. to subsec. (i). · (b)
• Pub. L. 100–203, §4042(b)(1)(D), as added by Pub. L. 100–360, §411(f)(2)(C), redesignated subpar. (G) as (F). Former subpar. (F) redesignated (E). · (b)
• Pub. L. 100–203, §4042(a), added subpar. (F). · (b)
• Pub. L. 100–203, §4042(b)(1)(D), as added by Pub. L. 100–360, §411(f)(2)(C), redesignated subpar. (G) as (F). · (b)
• Pub. L. 100–203, §4047(a), added subpar. (G). · (b)
• Pub. L. 100–203, §4085(i)(22)(C), as added by Pub. L. 100–360, §411(i)(4)(C)(vi), substituted "an assignment-related basis" for "the basis of an assignment described in paragraph (3)(B)(ii) or under the procedure described in section 1395gg(f)(1) of this title". · (b)
• Pub. L. 100–203, §4045(a), amended par. (10) generally, revising and restating as subpars. (A) to (D) provisions of former subpars. (A) to (C). · (b)
• Pub. L. 100–203, §4045(c)(2)(B), as amended by Pub. L. 100–360, §411(f)(4)(B)(i), struck out "and shall be further reduced by 2 percent with respect to procedures performed in 1988" after "in 1987" and struck out second sentence which read as follows: "A reduced prevailing ch… · (b)
• Pub. L. 100–203, §4063(a)(1)(A), designated existing provisions as cl. (i) and added cl. (ii). · (b)
• Pub. L. 100–203, §4046(a)(1)(B), (C), added subpar. (C) and redesignated former subpar. (C) as (D). · (b)
• Pub. L. 100–203, §4045(c)(1)(A), struck out former cl. (i) designation before "In the case of" and substituted ", the physician's actual charge is subject to a limit under subsection (j)(1)(D)." for "(subject to clause (iv)), the physician may not charge the individual more than the limiting charge… · (b)
• Pub. L. 100–203, §4063(a)(1)(B), which directed that subpar. (D) be amended by inserting "or item" after "service" or "services" each place either appears, was executed by inserting "or item" after "service" wherever appearing. The word "services" does not appear because of a pr… · (b)
• Pub. L. 100–203, §4046(a)(1)(A), (B), redesignated former subpar. (C) as (D) and substituted "subparagraph (B) or (C)" for "subparagraph (B)". · (b)
• Pub. L. 100–203, §4085(i)(25), as added by Pub. L. 100–360, §411(i)(4)(C)(vi), substituted "money penalty" for "monetary penalty" and amended second sentence generally. Prior to amendment, second sentence read as follows: "Such a penalty shall be imposed in the same manner as ci… · (b)
• Pub. L. 100–203, §4048(a), added par. (14). · (b)
• Pub. L. 100–203, §4041(a)(3)(A)(ii), designated existing provisions as subpar. (A) and added subpar. (B). · (c)
• Pub. L. 100–203, §4035(a)(2), inserted at end "The Secretary shall cause to have published in the Federal Register, by not later than September 1 before each fiscal year, data, standards, and methodology to be used to establish budgets for carriers under this section for that fiscal year, and shall… · (c)
• Pub. L. 100–203, §4031(a)(2), added par. (3). · (c)
• Pub. L. 100–203, §4081(a), designated existing provisions as subpar. (A) and added subpar. (B). · (h)
• Pub. L. 100–203, §4085(i)(6), substituted "the participation program" for "the the participation program". · (h)
• Pub. L. 100–203, §4042(b)(1)(A), as added by Pub. L. 100–360, §411(f)(2)(C), struck out ", described in paragraph (8)" after "assignment-related basis" in introductory provisions. · (h)
• Pub. L. 100–203, §4042(b)(1)(B), as added by Pub. L. 100–360, §411(f)(2)(C), substituted "(1) A" for "(8) For purposes of this subchapter, a", indented such par. 2 ems, and inserted subsec. (i) designation and "For purposes of this subchapter:", effectively transferring former subse… · (h)
• Pub. L. 100–203, §4042(b)(1)(B), as added by Pub. L. 100–360, §411(f)(2)(C), transferred introductory provisions and par. (1) from former subsec. (h)(8). · (i)
• Pub. L. 100–203, §4042(b)(1)(C), as added by Pub. L. 100–360, §411(f)(2)(C), transferred pars. (2) and (3) from subsec. (b)(4)(E). · (i), (3)
• Pub. L. 100–203, §4042(b)(1)(E), as added by Pub. L. 100–360, §411(f)(2)(C), added par. (4). · (i)
• Pub. L. 100–203, §4054(a)(1), (2), formerly §4053(a)(1), (2), as renumbered by Pub. L. 100–360, §411(f)(14), substituted "the actual charges of each such physician" for "each such physician's actual charges" and "on a repeated basis for such a service an actual charge" for "fo… · (j)
• Pub. L. 100–203, §4085(i)(7)(A), inserted "maximum allowable" after "If the physician's". · (j)
• Pub. L. 100–203, §4042(c)(2), as added by Pub. L. 100–360, §411(f)(2)(F)(ii), substituted "applicable percent (as defined in subsection (b)(4)(A)(iv)) of the prevailing charge for the year and service involved" for "prevailing charge for the year involved for such service furnished by nonparticipat… · (j)
• Pub. L. 100–203, §4085(i)(7)(B), substituted "1986" for "1987". · (j)
• Pub. L. 100–203, §4054(a)(3), formerly §4053(a)(3), as renumbered by Pub. L. 100–360, §411(f)(14), struck out "and subparagraph (B)" after "purposes of this subparagraph". · (j)
• Pub. L. 100–203, §4085(i)(7)(C), added cl. (vii). · (j)
• Pub. L. 100–203, §4041(a)(1)(B), as amended by Pub. L. 100–360, §411(f)(1)(A), added cl. (viii). · (j)
• Pub. L. 100–203, §4048(e), as added by Pub. L. 100–360, §411(f)(7)(B), added cl. (ix). · (j)
• Pub. L. 100–203, §4045(c)(1)(B), added subpar. (D). · (j)
• Pub. L. 100–203, §4063(a)(2)(A), added subcl. (IV) relating to establishment of reasonable charge limit under subsec. (b)(11)(C)(ii) of this section. · (j)
• Pub. L. 100–203, §4046(a)(2)(A), added subcl. (IV) relating to establishment of prevailing charge limit under subsec. (b)(11)(C)(i) of this section. Former subcl. (IV) redesignated (V). · (j)
• Pub. L. 100–203, §4063(a)(2)(A), redesignated former subcl. (V) as (VI). · (j), (VI)
• Pub. L. 100–203, §4046(a)(2)(A), redesignated former subcl. (IV) as (V). · (j), (VI)
• Pub. L. 100–203, §4063(a)(2)(B), as amended by Pub. L. 100–360, §411(g)(2)(C), struck out "or" at end of subcl. (I), substituted "; or" for period at end of subcl. (II), and added subcl. (III). · (j)
• Pub. L. 100–203, §4046(a)(2)(B), substituted ", (b)(11)(B), or (b)(11)(C)(i)" for "or (b)(11)(B)" in subcl. (II). · (j)
• Pub. L. 100–203, §4085(i)(26), as added by Pub. L. 100–360, §411(i)(4)(C)(vi), and amended by Pub. L. 100–485, §608(d)(24)(B), substituted "chapter" for "subchapter" in subpar. (A), struck out "the imposition of" before "civil monetary penalties" and inserted "and assessments" in su… · (j)
• Pub. L. 100–93, §8(c)(2)(A), amended subpar. (A) generally and substituted "excluded from participation in the programs" for "barred from participation in the program" in last sentence. Prior to amendment, subpar. (A) read as follows: "barring a physician from participation under the program under … · (j)
• Pub. L. 100–93, §8(c)(2)(B), substituted "exclude" for "bar". · (j)
• Pub. L. 100–203, §4085(g)(1), substituted "subsection (j)(2) in the case of surgery performed on or after March 1, 1987" for "subsection (j)(2)". · (k), (2)
• Pub. L. 100–203, §4096(a)(1)(B), designated existing provisions as subcl. (I) and added subcl. (II). · (l)
• Pub. L. 100–203, §4096(a)(1)(C), inserted "in the case described in subparagraph (A)(iii)(I)" after "to an individual" in introductory provisions. · (l)
• Pub. L. 100–203, §4085(i)(27), as added by Pub. L. 100–360, §411(i)(4)(C)(vi), inserted "the physician establishes that" after "(i)". · (l)
• Pub. L. 100–203, §4051(a), added subsec. (n). · (n)

1986

• Pub. L. 99–509, §9331(c)(3)(A), inserted "or (with respect to physicians services furnished in a year after 1987) the level determined under this sentence for the previous year" after "ending June 30, 1973," and "year-to-year" before "economic changes" in fourth sentence. · (b)
• Pub. L. 99–272, §9301(d)(1)(B), (C), substituted "June 30 last preceding the start of the calendar year" for "March 31 last preceding the start of the twelve-month period (beginning October 1 of each year)" in third sentence, and struck out "the twelve-month period beginning on October 1 in" before… · (b)
• Pub. L. 99–509, §9341(a)(2), substituted "at least $100, but not more than $500" for "$100 or more". · (b)
• Pub. L. 99–272, §9301(d)(1)(A), struck out "(ending on September 30)" after "before the year". · (b)
• Pub. L. 99–509, §9331(b)(2), added subpar. (G). · (b)
• Pub. L. 99–509, §9332(a)(1), added subpar. (H). · (b)
• Pub. L. 99–272, §9301(b)(1)(A), designated existing provisions as cl. (i) and added cl. (ii). · (b), (ii)
• Pub. L. 99–509, §9331(a)(1), added cl. (iii) and struck out former cl. (iii) which read as follows: "In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians' services furnished during a 12-month period beginning on or … · (b)
• Pub. L. 99–272, §9301(b)(1)(A)(ii), added cl. (iii). · (b)
• Pub. L. 99–509, §9331(a)(1), added cls. (iv) and (v). · (b), (v)
• Pub. L. 99–272, §9301(b)(1)(B), designated existing provisions as cl. (i) and added cl. (ii). · (b)
• Pub. L. 99–509, §9331(a)(2), directed amendment of subpar. (C) by striking out "(i)" after "(C)" and striking out cl. (ii), applicable to services furnished on or after Jan. 1, 1987, which is identical to amendment by Pub. L. 99–514, §1895(b)(14)(A), as amended, effective as if i… · (b)
• Pub. L. 99–514, §1895(b)(14)(A), as amended by Pub. L. 99–509, §9307(c)(2)(A), struck out cl. (i) designation, and struck out cl. (ii) which read as follows: "In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians' services furnished during … · (b)
• Pub. L. 99–272, §9301(b)(1)(C), designated existing provisions as cl. (i), substituted "subparagraph (A)(i)" for "subparagraph (A)" wherever appearing, and added cl. (ii). · (b)
• Pub. L. 99–272, §9301(b)(1)(D), designated existing provisions as cl. (i), substituted "In determining the customary charges for physicians' services furnished during the 8-month period beginning May 1, 1986, or the 12-month period beginning January 1, 1987, by a phys… · (b)
• Pub. L. 99–509, §9331(b)(3), added cl. (iv). · (b)
• Pub. L. 99–509, §9331(a)(3), added subpar. (E). · (b)
• Pub. L. 99–509, §9338(c), substituted "except that (A) payment may be made (i)" for "except that payment may be made (A)(i)", substituted "(B) payment may be made" for "or (B)", and inserted before the period at end ", and (C) in the case of services described in section 1395x(s)(2)… · (b)
• Pub. L. 99–272, §9219(b)(1)(A), realigned margin of subcl. (III). · (b)
• Pub. L. 99–272, §9219(b)(2)(A), realigned margin of cl. (iii). · (b)
• Pub. L. 99–509, §9333(a), designated existing provisions as subpar. (A), redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, and added subpars. (B) and (C). · (b)
• Pub. L. 99–272, §9304(a), added par. (8). · (b)
• Pub. L. 99–509, §9333(b), added par. (9). Former par. (9) redesignated (11). · (b)
• Pub. L. 99–272, §9306(a), added par. (9). · (b)
• Pub. L. 99–509, §9333(b), added par. (10). · (b)
• Pub. L. 99–509, §9334(a), designated existing provisions as subpar. (A), redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, and added subpars. (B) and (C). · (b)
• Pub. L. 99–509, §9333(b), redesignated former par. (9) as (11). · (b)
• Pub. L. 99–509, §9338(b), added par. (12). · (b)
• Pub. L. 99–509, §9311(c), designated existing provisions as par. (1) and added par. (2). · (c)
• Pub. L. 99–272, §9301(d)(2), substituted "before the beginning of any year beginning with 1984" for "before October 1 of any year beginning with 1984", "on an assignment-related basis" for "on the basis of an assignment described in subsection (b)(3)(B)(ii) of this section, in accor… · (h)
• Pub. L. 99–509, §9332(b)(1)(A), struck out period at end and substituted "and may request a copy of an appropriate directory published under paragraph (4). Each such carrier shall, without charge, mail a copy of such directory upon such a request." · (h)
• Pub. L. 99–509, §9332(b)(2), inserted at end "Each participating physician directory for an area shall provide an alphabetical listing of all participating physicians practicing in the area and an alphabetical listing by locality and specialty of such physicians." · (h)
• Pub. L. 99–272, §9301(c)(3)(D), redesignated par. (2) of subsec. (i) as par. (4) of this subsection. · (h)
• Pub. L. 99–509, §9332(b)(1)(B), substituted "the participation program under this subsection and the publication and availability of the directories" for "publication of the directories" and inserted at end "The Secretary shall include such notice in the mailing of appropriate benef… · (h)
• Pub. L. 99–514, §1895(b)(15)(A), struck out "such" before "the directories" and before "the appropriate area directory". · (h)
• Pub. L. 99–272, §9301(c)(3)(D), redesignated par. (3) of subsec. (i) as par. (5) of this subsection. · (h)
• Pub. L. 99–509, §9332(b)(1)(C), inserted before period at end of second sentence "and that an appropriate number of copies of each such directory is sent to hospitals located in the area" and inserted at end "Such copies shall be sent free of charge." · (h)
• Pub. L. 99–514, §1895(b)(15)(B), substituted "the" for "the the" before "directories". · (h)
• Pub. L. 99–272, §9301(c)(3)(D), redesignated par. (4) of subsec. (i) as par. (6) of this subsection. · (h)
• Pub. L. 99–272, §9301(c)(4), added pars. (7) and (8). · (h), (8)
• Pub. L. 99–272, §9301(c)(3)(A), struck out par. (1) which required the Secretary to publish a list containing the name, address, specialty, and percent of claims submitted with respect to each physician and supplier during preceding year that were paid on the basis of an assignment … · (i)
• Pub. L. 99–272, §9301(c)(3)(D), redesignated par. (2) of this subsection as par. (4) of subsec. (h). · (i)
• Pub. L. 99–272, §9301(d)(3), substituted "year" for "fiscal year", wherever appearing. · (i)
• Pub. L. 99–272, §9301(c)(2)(A), (B), (3)(B), substituted "shall publish directories (for appropriate local geographic areas)" for "shall publish a directory", inserted "for that area" before "for that fiscal year", substituted "Each directory shall" for "The directory shall", and substituted "parag… · (i)
• Pub. L. 99–272, §9301(c)(3)(D), redesignated par. (3) of this subsection as par. (5) of subsec. (h). · (i)
• Pub. L. 99–272, §9301(c)(2)(C), (3)(C), struck out "directory" first place it appeared and inserted in lieu "the directories", struck out "directory" second place it appeared and inserted in lieu "the appropriate area directory or directories", and struck out "list and" wherever appearing. · (i)
• Pub. L. 99–272, §9301(c)(3)(D), redesignated par. (4) of this subsection as par. (6) of subsec. (h). · (i)
• Pub. L. 99–272, §9301(c)(2)(D), (3)(C), struck out "list and" after "The Secretary shall provide that the" in first sentence, substituted "the directories shall" for "directory shall", and inserted provision requiring the Secretary to provide that each appropriate area directory be sent to each par… · (i)
• Pub. L. 99–509, §9331(b)(1), designated existing provisions as subpar. (A) and added subpars. (B) and (C). · (j)
• Pub. L. 99–272, §9301(b)(2), amended first sentence generally. Prior to amendment, first sentence read as follows: "In the case of a physician who is not a participating physician, the Secretary shall monitor each such physician's actual charges to individuals enrolled under this part for physician… · (j)
• Pub. L. 99–509, §9320(e)(3), substituted "this paragraph" for "paragraph (1) or subsection (k) of this section" in introductory text. · (j)
• Pub. L. 99–272, §9307(c)(1), inserted reference to subsec. (k) of this section in introductory text. · (j)
• Pub. L. 99–514, §1895(b)(16)(A), inserted "presents or causes to be presented a claim or" in pars. (1) and (2). · (k)
• Pub. L. 99–272, §9307(c)(2), added subsec. (k). · (k)
• Pub. L. 99–509, §9332(c)(1), added subsec. (l). · (l)
• Pub. L. 99–509, §9332(d)(1), added subsec. (m). · (m)

1984

• Pub. L. 98–369, §2326(c)(2), inserted at end provision that the Secretary publish in the Federal Register standards and criteria for efficient and effective performance of contract obligations under this section and provide an opportunity for public comment prior to implementation. · (b)
• Pub. L. 98–369, §2306(b)(1)(B), (C), substituted "during the 12-month period ending on the March 31 last preceding" for "during the last preceding calendar year elapsing prior to" in third sentence and substituted "October 1" for "July 1" wherever appearing in third and eighth sente… · (b)
• Pub. L. 98–369, §2354(b)(14), substituted "(I)" and "(II)" for "(i)" and "(ii)", respectively in concluding provisions. · (b)
• Pub. L. 98–369, §2663(j)(2)(F)(iv), substituted "Health and Human Services" for "Health, Education, and Welfare" in concluding provisions. · (b)
• Pub. L. 98–369, §2354(b)(13), struck out the period after "subchapter". · (b)
• Pub. L. 98–369, §2306(b)(1)(A), substituted "September 30" for "June 30". · (b)
• Pub. L. 98–369, §2306(a), added par. (4) and redesignated former pars. (4) and (5) as (5) and (6), respectively. · (b), (5)
• Pub. L. 98–369, §2339, redesignated cl. (A) as cl. (A)(i) and former cl. (B) as cl. (A)(ii), added a new cl. (B), and in the provisions after cl. (B), substituted "clause (A) of such sentence" for "clause (A) or (B) of such sentence". · (b)
• Pub. L. 98–369, §2306(a), redesignated par. (5) as (6). Former par. (6) redesignated (7). · (b)
• Pub. L. 98–369, §2306(a), redesignated par. (6) as (7). · (b)
• Pub. L. 98–617, §3(b)(5)(B), struck out at end "If all the teaching physicians in a hospital agree to have payment made for all of their physicians' services under this part furnished patients in the hospital on the basis of an assignment described in paragraph (3)(B)(ii) or unde… · (b)
• Pub. L. 98–369, §2307(a)(1), as amended by Pub. L. 98–617, §3(a)(1), inserted "If all the teaching physicians in a hospital agree to have payment made for all of their physicians' services under this part furnished patients in the hospital on the basis of an assignment described in paragraph (3)(B)… · (b)
• Pub. L. 98–617, §3(b)(5)(A), substituted "the payment is based upon a reasonable charge for the services in excess of the customary charge as determined in accordance with subparagraph (B)" for "the amount of the payment exceeds the reasonable charge for the services (with th… · (b)
• Pub. L. 98–369, §2307(a)(2)(A), (B), substituted "physician who is not a teaching physician (as defined by the Secretary)" for "physician who has a substantial practice outside the teaching setting" and "practice outside the teaching setting" for "outside practice". · (b)
• Pub. L. 98–369, §2307(a)(2)(C), (D), substituted "In the case of a teaching physician" for "In the case of a physician who does not have a practice described in clause (i)" and "greatest" for "greater". · (b)
• Pub. L. 98–369, §2307(a)(2)(E)–(G), added subcl. (III). · (b)
• Pub. L. 98–617, §3(b)(6), added cl. (iii). · (b)
• Pub. L. 98–369, §2326(d)(2), inserted provision that the Secretary, in determining a carrier's necessary and proper cost of administration with respect to each contract, take into account the amount that is reasonable and adequate to meet the costs which must be incurred by an efficien… · (c)
• Pub. L. 98–369, §2306(c), added subsec. (h). · (h)
• Pub. L. 98–369, §2303(e), struck out subsec. (h) providing for payment for laboratory tests. · (h)
• Pub. L. 98–369, §2306(c), added subsecs. (i) and (j). · (i), (j)

1982

• Pub. L. 97–248, §128(d)(1), substituted "section 1395y(a)" for "section 1395y". · (b)
• Pub. L. 97–248, §104(a), in provisions following subpar. (F), inserted provisions that in determining the reasonable charge for outpatient services, the Secretary may limit such reasonable charge to a percentage of the amount of the prevailing charge for similar services furnished i… · (b)
• Pub. L. 97–248, §113(a), added subpar. (D). · (b)

1981

• Pub. L. 97–35 inserted provision that the amount of any charges for outpatient services which shall be considered reasonable shall be subject to the limitations established by regulations issued by the Secretary pursuant to section 1395x(v)(1)(K) of this title. · (b)

1980

• Pub. L. 96–499, §946(a), in provisions following subpar. (F), substituted "service is rendered" for "bill is submitted or the request for payment is made". · (b)
• Pub. L. 96–499, §946(b), added subpar. (F). · (b)
• Pub. L. 96–499, §948(b), added par. (6). · (b)
• Pub. L. 96–499, §918(a)(1), added subsec. (h). · (h)

1977

• Pub. L. 95–216 provided that, with respect to power-operated wheelchairs for which payment may be made in accordance with section 1395x(s)(6) of this title, charges determined to be reasonable may not exceed the lowest charge at which power-operated wheelchairs are available in the … · (b)
• Pub. L. 95–142 inserted provisions relating to payments under a reassignment or power of attorney in cases other than direct payments to physicians or service providers. · (b)

1976

• Pub. L. 94–368 substituted "for the twelve-month period beginning on July 1 in any calendar year after 1974" for "for the fiscal year beginning July 1, 1975,", "prior to the start of the twelve-month period (beginning July 1, of each year) in which the bill is submitted or the reque… · (b)

1975

• Pub. L. 94–182 inserted provisions relating to raising for fiscal year beginning July 1, 1975 inadequate prevailing charge levels for services of physicians in certain localities. · (b)

1974

• Pub. L. 93–445 substituted "section 231f(d) of title 45" for "section 228s–2(b) of title 45". · (g)

1972

• Pub. L. 92–603, §227(e)(3), substituted "which involve payments for physicians' services on a reasonable charge basis" for "which involve payments for physicians' services". · (a)
• Pub. L. 92–603, §§244(a), 258(a), inserted provisions relating to determination of reasonableness of physician charges, medical services, supplies, and equipment and for the extension of time for filing claims for supplementary medical insurance benefits where the delay is due to ad… · (b)
• Pub. L. 92–603, §§211(c)(3), 281(d), designated existing provisions as subcl. (I), added subcl. II, inserted exception in the case of services furnished as described in section 1395y(a)(4) of this title, other than for purposes of section 1395gg(f) of this title. · (b)
• Pub. L. 92–603, §262(a), inserted provisions setting a $100 minimum amount on claims to establish entitlement to a hearing. · (b)
• Pub. L. 92–603, §236(a), added par. (5). · (b)
• Pub. L. 92–603, §263(d)(5), added subsec. (g). · (g)

1968

• Pub. L. 90–248 provided that payment be made on the basis of an itemized bill instead of a receipted bill as formerly required, and established a time limit within which payment may be requested, and inserted "(except as otherwise provided in section 1395gg(f) of this title)" aft… · (b)