PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-99 " (4) LIMIT. — "(A) $55, INDEXED.— Except as provided by the Secretary under subparagraph (B), the limit established under this paragraph— "(i) for screening mammography performed in 1991, is $55, and "(ii) for screening mammography performed in a subsequent year is the limit established under this paragraph for the preceding year increased by the percentage increase in the MEI for that subsequent year. "(B) REDUCTION OF LIMIT.— The Secretary shall review from time to time the appropriateness of the amount of the limit established under this paragraph. The Secretary may, with respect to screening mammography performed in a year after 1992, reduce the amount of such limit as it applies nationally or in any area to the amount that the Secretary estimates is required to assure that screening mammography of an appropriate quality is readily and conveniently available during the year. " (C) APPLICATION OF LIMIT IN HOSPITAL OUTPATIENT SET- TING. —The Secretary shall provide for an appropriate allocation of the limit established under this paragraph between professional and technical components in the case of hospital outpatient screening mammography (and comparable situations) where there is a claim for professional services separate from the claim for the radiologic procedure. " (5) LIMITING CHARGES OF NONPARTICIPATING PHYSICIANS. — "(A) IN GENERAL. — In the case of mammography screening performed on or after January 1, 1991, for which pay- ment is made under this subsection, if a nonparticipating physician or supplier provides the screening to an individual entitled to benefits under this part, the physician or supplier may not charge the individual more than the limiting charge (as defined in subparagraph (B), or if less, as defined in subsection (b)(5)(B) or as defined in section 1848(g)(2)). "(B) LIMITING CHARGE DEFINED. — In subparagraph (A), the term 'limiting charge' means, with respect to screening mammography performed— "(i) in 1991, 125 percent of the limit established under paragraph (4), "(ii) in 1992, 120 percent of the limit established under paragraph (4), or "(iii) after 1992, 115 percent of the limit established under paragraph (4). "(C) ENFORCEMENT. — If a physician or supplier knowing and willfully imposes a charge in violation of subparagraph (A), the Secretary may apply sanctions against such physician or supplier in accordance with section 1842(j)(2).". (c) CERTIFICATION OF SCREENING MAMMOGRAPHY QUALITY STAND- ARDS.— (1) Section 1863 of such Act (42 U.S.C. 1395z) is amended by inserting "or whether screening mammography meets the standards established under section 1834(c)(3)," after "1832(a)(2)(F)(i),".