I 

118TH CONGRESS 

2D SESSION H. R. 10136 

To amend title XVIII of the Social Security Act to align payment under 

Medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 15, 2024 

Mr. BILIRAKIS (for himself, Mr. DAVIS of Illinois, and Mr. MURPHY) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committee on Ways and Means, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to align 

payment under Medicare for specified surgical procedures 

with high-cost supplies furnished in office-based facilities, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Promoting Fairness 

5 for Medicare Providers Act of 2024’’. 


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1 SEC. 2. ALIGNING PAYMENT UNDER MEDICARE FOR SPECI2 FIED HIGH SUPPLY COST SURGICAL PROCE3 DURES FURNISHED IN OFFICE-BASED FACILI4 TIES. 

5 (a) COVERAGE OF FACILITY SERVICES.—Section 

6 1832(a)(2)(F) of the Social Security Act (42 U.S.C. 

7 1395k(a)(2)(F)) is amended— 

8 (1) in the matter preceding clause (i), by strik9 ing ‘‘specified by the Secretary’’; 

10 (2) in clause (i)— 

11 (A) by inserting ‘‘specified by the Sec12 retary’’ before ‘‘pursuant’’; and 

13 (B) at the end, by striking ‘‘or’’; 

14 (3) in clause (ii)— 

15 (A) by inserting ‘‘specified by the Sec16 retary’’ before ‘‘pursuant’’; and 

17 (B) at the end, by striking the semicolon 

18 and inserting ‘‘, or’’; and 

19 (4) by adding at the end the following new 

20 clause: 

21 ‘‘(iii) that are specified high supply 

22 cost surgical procedures (as defined in sec23 tion 1834(aa)(4) with respect to a year 

24 (beginning with 2025) and furnished dur25 ing such year in an office-based facility (as 

26 defined in section 1834(aa)(5));’’. 


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1 (b) PAYMENT RULES.— 

2 (1) PAYMENT FOR FACILITY SERVICES.—Sec3 tion 1833(a)(1) of the Social Security Act (42 

4 U.S.C. 1395l(a)) is amended— 

5 (A) by striking ‘‘and (HH)’’ and inserting 

6 ‘‘(HH)’’; and 

7 (B) by inserting before the semicolon at 

8 the end the following ‘‘, and (II) with respect 

9 to facility services furnished in connection with 

10 a specified high supply cost surgical procedure 

11 (as defined in section 1834(aa)(4)) with respect 

12 to a year (beginning with 2025) furnished to an 

13 individual in an office-based facility (as defined 

14 in section 1834(aa)(5)) during such year, the 

15 amounts paid shall be, subject to section 

16 1834(aa)(3), 80 percent of the payment amount 

17 determined under section 1834(aa) for such fa18 cility services furnished in connection with such 

19 procedure at such office-based facility’’. 

20 (2) PAYMENT DETERMINATION FOR SPECIFIED

21 HIGH SUPPLY COST SURGICAL PROCEDURES FUR22 NISHED IN OFFICE-BASED FACILITIES.—Section 

23 1834 of the Social Security Act (42 U.S.C. 

24 1395l(a)) is amended by adding at the end the fol25 lowing new subsection: 


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1 ‘‘(aa) PAYMENT FOR SPECIFIED HIGH SUPPLY COST

2 SURGICAL PROCEDURES FURNISHED IN OFFICE-BASED

3 FACILITIES.— 

4 ‘‘(1) IN GENERAL.—In the case of a specified 

5 high supply cost surgical procedure furnished in an 

6 office-based facility during 2025 or a subsequent 

7 year, subject to paragraphs (2) and (3), payment for 

8 such procedure shall be determined under this part 

9 in the same manner as payment would be deter10 mined under this part if such procedure had been 

11 furnished in an ambulatory surgical center and not 

12 considered office-based under section 1833(i)(1)(B), 

13 except that payment for facility services furnished in 

14 connection with such procedure shall be equal to 90 

15 percent of the amount that would be payable for fa16 cility services furnished in connection with such pro17 cedure under section 1833(i) for such year if such 

18 procedure had been furnished in an ambulatory sur19 gical center and treated as a service commonly fur20 nished in such a center. 

21 ‘‘(2) APPLICATION IN CASE OF DEVICE-INTEN22 SIVE PROCEDURES.—In applying paragraph (1) in 

23 the case of a specified high supply cost surgical pro24 cedure that is a device-intensive procedure (as de25 scribed in section 416.171(b)(2) of title 42, Code of 


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1 Federal Regulations (or any successor regulation)), 

2 instead of the payment amount applied under such 

3 paragraph, the payment amount for the facility serv4 ices with respect to such procedure shall be the 

5 amount that would be calculated under section 

6 416.172(h)(2)(ii) of title 42, Code of Federal Regu7 lations (or any successor regulation) with respect to 

8 a procedure that has been assigned device-intensive 

9 status, except that in applying such calculation the 

10 non-device portion described in paragraph (B) of 

11 such section shall be equal to 90 percent of the 

12 amount that would otherwise be calculated for such 

13 portion. 

14 ‘‘(3) LIMITATION ON COPAYMENT AMOUNT TO

15 INPATIENT HOSPITAL DEDUCTIBLE AMOUNT.— 

16 ‘‘(A) IN GENERAL.—In no case shall the 

17 amount of coinsurance for facility services fur18 nished in connection with a specified high sup19 ply cost surgical procedure in an office-based 

20 facility during a year exceed the amount of the 

21 inpatient hospital deductible established under 

22 section 1813(b) for that year. 

23 ‘‘(B) MAINTAINING PAYMENT TO PRO24 VIDER.—In the case that an individual enrolled 

25 under this part would, without application of 


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1 subparagraph (A), be subject to an amount of 

2 coinsurance for facility services furnished in 

3 connection with a specified high supply cost 

4 surgical procedure in an office-based facility 

5 during a year that exceeds the amount of the 

6 inpatient hospital deductible established under 

7 section 1813(b) for that year, the Secretary 

8 shall increase the amount paid to the office9 based facility as specified under section 

10 1833(a)(1)(II) for such facility services by the 

11 amount by which— 

12 ‘‘(i) the coinsurance payable by the in13 dividual for such facility services without 

14 application of this paragraph; exceeds 

15 ‘‘(ii) the coinsurance payable by the 

16 individual for such facility services with ap17 plication of this paragraph. 

18 ‘‘(4) SPECIFIED HIGH SUPPLY COST SURGICAL

19 PROCEDURE DEFINED.— 

20 ‘‘(A) IN GENERAL.—For purposes of this 

21 part, subject to subparagraphs (B) and (C), the 

22 term ‘specified high supply cost surgical proce23 dure’ means a surgical procedure that as of 

24 2023— 


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1 ‘‘(i) when performed in an ambulatory 

2 surgical center, was payable under section 

3 1833(i); and 

4 ‘‘(ii) when performed in a physician’s 

5 office— 

6 ‘‘(I) was payable under section 

7 1848 at the practice expense relative 

8 value unit-based amount for non-facil9 ity sites of service; and 

10 ‘‘(II) included a HCPCS code 

11 with a supply item for which the price 

12 input for such supply item, used for 

13 determining the practice expense rel14 ative value units for such code, was 

15 greater than $500. 

16 ‘‘(B) REVIEW AND REVISIONS TO SPECI17 FIED SERVICES.— 

18 ‘‘(i) IN GENERAL.—For each year (be19 ginning with 2026), the Secretary shall re20 view the procedures included in the defini21 tion of specified high supply cost surgical 

22 procedures under this paragraph and, 

23 based on such review and through rule24 making— 


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1 ‘‘(I) shall add a surgical proce2 dure (not described in subparagraph 

3 (A)) for inclusion in such definition if 

4 the procedure, with respect to such 

5 year, satisfies the criteria specified in 

6 clause (ii); and 

7 ‘‘(II) may remove a surgical pro8 cedure from inclusion in such defini9 tion if the procedure, with respect to 

10 such year, satisfies the criteria speci11 fied in clause (iii). 

12 ‘‘(ii) CRITERIA FOR REQUIRED INCLU13 SION.—For purposes of clause (i)(I), a sur14 gical procedure satisfies the criteria speci15 fied in this clause, with respect to a year, 

16 if— 

17 ‘‘(I) when performed in an ambu18 latory surgical center, the procedure is 

19 payable under section 1833(i); and 

20 ‘‘(II) when performed in a physi21 cian’s office, the procedure— 

22 ‘‘(aa) would be, without ap23 plication of this subsection or 

24 section 1833(a)(i)(II), payable 

25 under section 1848 at the pracVerDate Sep 11 2014 01:19 Nov 16, 2024 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H10136.IH H10136

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1 tice expense relative value unit2 based amount for non-facility 

3 sites of services; and 

4 ‘‘(bb) includes a HCPCS 

5 code with a supply item for which 

6 the price input for such supply 

7 item, used for determining the 

8 practice expense relative value 

9 units for such code, is greater 

10 than the threshold specified in 

11 clause (iv) for such year. 

12 ‘‘(iii) CRITERIA FOR PERMISSIVE RE13 MOVAL.—For purposes of clause (i)(II), a 

14 surgical procedure satisfies the criteria de15 scribed in this clause, with respect to a 

16 year, if, when performed in a physician’s 

17 office, the procedure includes a HCPCS 

18 code with a supply item for which the price 

19 input for such supply item, used for deter20 mining the practice expense relative value 

21 units for such code, does not exceed the 

22 amount equal to 80 percent of the thresh23 old specified in clause (iv) for such year. 

24 ‘‘(iv) DOLLAR AMOUNT THRESHOLD

25 SPECIFIED.—For purposes of clauses (ii) 


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1 and (iii), the threshold specified in this 

2 clause is— 

3 ‘‘(I) with respect to 2026, the 

4 dollar amount specified in subpara5 graph (A)(ii), increased by the per6 centage increase in the MEI (as de7 fined in section 1842(i)(3)) over the 

8 3-year period ending with 2026; or 

9 ‘‘(II) with respect to a subse10 quent year, the amount specified in 

11 this clause for the preceding year in12 creased by the percentage increase in 

13 the MEI (as defined in section 

14 1842(i)(3)) for such subsequent year. 

15 ‘‘(C) SPECIAL RULE FOR USE OF MORE

16 THAN ONE OF THE SAME SUPPLY ITEM IN A

17 PROCEDURE.—In the case of a surgical proce18 dure that requires the use of more than one of 

19 the same supply item in such procedure— 

20 ‘‘(i) in applying subparagraph 

21 (A)(ii)(II), if as of 2023 the sum of the 

22 price inputs described in such subpara23 graph of all of such same supply items ex24 ceeds the dollar amount specified in such 

25 subparagraph, then the procedure shall be 


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1 treated as satisfying the requirement of 

2 such subparagraph; and 

3 ‘‘(ii) in applying subparagraph (B), 

4 with respect to 2026 or a subsequent 

5 year— 

6 ‘‘(I) if the sum of the price in7 puts described in clause (ii)(II)(bb) of 

8 such subparagraph of all of such same 

9 supply items exceeds the threshold 

10 specified in clause (iv) of such sub11 paragraph for such year, then the pro12 cedure shall be treated as satisfying 

13 the criterion described in such clause 

14 (ii)(II)(bb) with respect to such year; 

15 and 

16 ‘‘(II) if the sum of the price in17 puts described in clause (iii) of such 

18 subparagraph of all of such same sup19 ply items does not exceed the amount 

20 described in such clause for such year, 

21 then the procedure shall be treated as 

22 satisfying the criteria described in 

23 such clause with respect to such year. 

24 ‘‘(5) OFFICE-BASED FACILITY DEFINED.—For 

25 purposes of this part, the term ‘office-based facility’ 


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1 means a physician’s office that, with respect to facil2 ity services furnished in connection with specified 

3 high supply cost surgical procedures— 

4 ‘‘(A) meets health, safety, and other stand5 ards specified by the Secretary in regulations; 

6 and 

7 ‘‘(B) has entered into an agreement with 

8 the Secretary under which the physician’s of9 fice— 

10 ‘‘(i) accepts the payment amount de11 termined under this subsection as full pay12 ment for such facility services; 

13 ‘‘(ii) accepts an assignment described 

14 in section 1842(b)(3)(B)(ii) with respect to 

15 payment for all such facility services fur16 nished by the office to individuals enrolled 

17 under this part; and 

18 ‘‘(iii) participates under this part and 

19 is paid as an office-based facility with re20 spect to all such procedures.’’. 

21 (3) CONFORMING AMENDMENTS.— 

22 (A) FOR SERVICES FURNISHED IN AN AM23 BULATORY SURGICAL CENTER.—Section 

24 1833(i)(2) of the Social Security Act (42 


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1 U.S.C. 1395l(i)(2)) is amended by adding at 

2 the end the following new subparagraph: 

3 ‘‘(F) For purposes of determining payment 

4 under this subsection for a specified high sup5 ply cost surgical procedure (as defined in sec6 tion 1834(aa)(4) with respect to a year (begin7 ning with 2025)) furnished in an ambulatory 

8 surgical center during such year, such proce9 dure shall be treated as a service commonly fur10 nished in an ambulatory surgical center.’’. 

11 (B) FOR SERVICES FURNISHED IN AN OFF12 CAMPUS OUTPATIENT DEPARTMENT OF A PRO13 VIDER.—Section 1833(t)(21)(C) of the Social 

14 Security Act (42 U.S.C. 1395l(t)(21)(C)) is 

15 amended by adding at the end the following 

16 new sentence: ‘‘In applying the previous sen17 tence in the case of a specified high supply cost 

18 surgical procedure (as defined in section 

19 1834(aa)(4) with respect to a year) furnished 

20 by an off-campus outpatient department of a 

21 provider, payment shall be determined under 

22 section 1834(aa).’’. 

23 (C) FOR CLARIFICATION ON APPLICABLE

24 PAYMENT FOR OBF FACILITY SERVICES.—Sec25 tion 1833(a)(4) of the Social Security Act (42 


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1 U.S.C. 1395l(a)(4)) is amended by inserting 

2 ‘‘(other than in clause (iii) of such section)’’ 

3 after ‘‘section 1832(a)(2)(F)’’. 

4 (c) PROVIDER AGREEMENT AND MEDICARE ENROLL5 MENT.— 

6 (1) IN GENERAL.—Section 1866(e) of the So7 cial Security Act (42 U.S.C. 1395cc(e)) is amend8 ed— 

9 (A) in paragraph (2), by striking at the 

10 end ‘‘and’’; 

11 (B) in paragraph (3), at the end, by strik12 ing the period and adding ‘‘; and’’; and 

13 (C) by adding at the end the following new 

14 paragraph: 

15 ‘‘(4) an office-based facility (as defined in para16 graph (5) of section 1834(aa)), but only with respect 

17 to the furnishing during a year of specified high 

18 supply cost surgical procedures (as defined in para19 graph (4) of such section with respect to such 

20 year).’’. 

21 (2) CONSULTATION WITH STATE AGENCIES RE22 GARDING CONDITIONS OF PARTICIPATION.—Section 

23 1863 of the Social Security Act (42 U.S.C. 1395z) 

24 is amended by striking ‘‘or by ambulatory surgical 

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1 ing ‘‘by ambulatory surgical centers under section 

2 1832(a)(2)(F)(i), or by office-based facilities (as de3 fined in section 1834(aa)(5)) with respect to fur4 nishing specified high supply cost surgical proce5 dures (as defined in section 1834(aa)(4))’’. 

6 (3) USE OF STATE AGENCIES TO DETERMINE

7 COMPLIANCE WITH CONDITIONS OF PARTICIPA8 TION.—Section 1864(a) of the Social Security Act 

9 (42 U.S.C. 1395aa(a)) is amended— 

10 (A) in the first sentence, by inserting ‘‘or 

11 whether a physician’s office is an office-based 

12 facility (as defined in section 1834(aa)(5),’’ 

13 after ‘‘standards specified under section 

14 1832(a)(2)(F)(i),’’; and 

15 (B) in the fifth sentence, by inserting ‘‘of16 fice-based facility (as defined in section 

17 1834(aa)(5)) with respect to furnishing ambula18 tory high supply cost surgical procedures (as 

19 defined in section 1834(aa)(4)),’’ after each oc20 currence of ‘‘ambulatory surgical center,’’. 

Æ 


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