PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-63 (2) by striking "; or" at the end and inserting ", or", and (3) by adding at the end the following new subparagraph: "(B) which are for services of an assistant at surgery to which section 1848(i)(2)(B) applies; or". (c) EFFECTIVE DATE.—The amendment made by subsection shall apply with respect to services furnished on or after January 1, 1992. SEC. 4108. TECHNICAL COMPONENTS OF CERTAIN DIAGNOSTIC TESTS. (a) IN GENERAL.— Section 1842(b) of the Social Security Act (42 U.S.C. 1395u(b)), as amended by section 4101, is further amended by adding at the end the following new paragraph: "(18) With respect to payment under this part for the technical (as distinct from professional) component of diagnostic tests (other than clinical diagnostic laboratory tests and radiology services, including portable x-ray services) which the Secretary shall designate (based on their high volume of expenditures under this part), the reasonable charge for such technical component (including the applicable portion of a global service) may not exceed the national median of such charges for all localities, as estimated by the Secretary using the best available data.". (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to tests and services furnished on or after January 1, 1991. SEC. 4109. INTERPRETATION OF ELECTROCARDIOGRAMS. (a) IN GENERAL. — Section 1848(b) of the Social Security Act (42 U.S.C. 1395w-4(b)) is amended by adding at the end the following new paragraph: "(3) TREATMENT OF INTERPRETATION OF ELECTROCARDIO- GRAMS. — If payment is made under this part for a visit to a physician or consultation with a physician and, as part of or in conjunction with the visit or consultation there is an electrocardiogram performed or ordered to be performed, no payment may be made under this part with respect to the interpretation of the electrocardiogram and no physician may bill an individual enrolled under this part separately for such an interpretation. If a physician knowingly and willfully bills one or more individuals in violation of the previous sentence, the Secretary may apply sanctions against the physician or entity in accordance with section 1842(j)(2).". (b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to services furnished on or after January 1, 1992. In applying section 1848(d)(1)(B) of the Social Security Act (in computing the initial budget-neutral conversion factor for 1991), the Secretary shall compute such factor assuming that section 1848(b)(3) of such Act (as added by the amendment made by subsection (a)) had applied to physicians' services furnished during 1991. SEC. 4110. RECIPROCAL BILLING ARRANGEMENTS. (a) IN GENERAL.—The first sentence of section 1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6)) is amended— (1) by striking "and" before "(C)", and (2) by inserting before the period at the end the following: ", and (D) 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 on an occasional, reciprocal basis if (i) the first physician is unavail- 42 USC 1395y note. 42 USC 1395u note. 42 USC 1395W-4 note.
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