I 

111TH CONGRESS 

1ST SESSION H. R. 4371 

To amend title XVIII of the Social Security Act to continue using 2009 

Medicare practice expense relative value units for certain cardiology services. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2009 

Mr. GONZALEZ (for himself, Mr. ORTIZ, Mr. BOREN, Mr. GRIFFITH, Mr. 

THORNBERRY, Mr. MEEK of Florida, Mr. COURTNEY, Mr. GARRETT of 

New Jersey, Mr. ARCURI, Mr. CARNAHAN, Mr. HALL of Texas, Mr. 

RUPPERSBERGER, Mr. MORAN of Virginia, Mr. SCOTT of Georgia, Mr. 

AKIN, Mr. PITTS, Mr. CUELLAR, Mr. KAGEN, Mr. MCINTYRE, Mr. GRAYSON, Mrs. MCCARTHY of New York, Mr. BISHOP of Georgia, Mr. 

CUMMINGS, Mr. MASSA, Mr. BARTLETT, Mr. COHEN, Mr. PETERS, Mr. 

BERRY, Mr. HIMES, Ms. MCCOLLUM, Mr. BISHOP of New York, Mrs. 

LOWEY, Mr. MAFFEI, Mr. CLAY, Mr. MURPHY of New York, Mrs. 

CHRISTENSEN, Mr. KRATOVIL, Mr. ROE of Tennessee, Mr. WITTMAN, 

Mr. BUTTERFIELD, Mr. ISRAEL, Mr. LUETKEMEYER, Mr. RUSH, Mr. 

MARCHANT, Mr. HILL, Ms. WASSERMAN SCHULTZ, Mr. LINCOLN DIAZBALART of Florida, Ms. NORTON, Mr. LOBIONDO, Ms. KOSMAS, Mr. 

DENT, Mr. FALEOMAVAEGA, Mrs. BIGGERT, Mr. ADLER of New Jersey, 

Mr. GERLACH, and Mr. PAUL) 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 continue 

using 2009 Medicare practice expense relative value units 

for certain cardiology services. 


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

3 SECTION 1. CONTINUED USE OF 2009 MEDICARE PRACTICE 

4 EXPENSE RELATIVE VALUE UNITS FOR CER5 TAIN CARDIOLOGY SERVICES. 

6 Section 1848(c)(2) of the Social Security Act (42 

7 U.S.C. 1395w–4(c)(2)) is amended by adding at the end 

8 the following new subparagraph: 

9 ‘‘(K) CONTINUED USE OF 2009 PRACTICE

10 EXPENSE RELATIVE VALUE UNITS FOR CERTAIN

11 CARDIOLOGY SERVICES.— 

12 ‘‘(i) IN GENERAL.—Notwithstanding 

13 any other provision of law, including provi14 sions contained in the final rule published 

15 in the Federal Register on November 25, 

16 2009 (74 Fed. Reg. 61737), relating to CY 

17 2010 relative value units, subject to clause 

18 (iii) and the second sentence of clause (iv), 

19 in determining the practice expense pay20 ment under this paragraph for services 

21 performed predominantly by cardiologists 

22 and furnished on or after January 1, 2010, 

23 the Secretary shall continue practice ex24 pense relative value units at the levels for 

25 CY 2009 for such services. For purposes of 


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1 the previous sentence, the services per2 formed predominantly by cardiologists in3 clude (as determined by the Secretary) car4 diac monitoring services, services per5 formed primarily for the diagnosis or treat6 ment of heart disease, and other services 

7 at least 50 percent of which are performed 

8 under this part by cardiologists. 

9 ‘‘(ii) INCLUSION OF SPECIFIC CARDIAC

10 CODES.—In determining practice expense 

11 relative value units under this paragraph 

12 for myocardial perfusion imaging (CPT 

13 codes 78451–78454) for services furnished 

14 on or after January 1, 2010, subject to 

15 clause (iii) and the second sentence of 

16 clause (iv), the Secretary shall use the 

17 2009 practice expense relative value units 

18 for the previous codes that were combined 

19 to create such CPT codes. 

20 ‘‘(iii) NEW CPT CODE IMPLEMENTA21 TION PERMITTED.—Nothing in clause (i) 

22 or (ii) shall be construed to prevent new 

23 category I CPT codes related to cardio24 vascular computed tomography and cardio25 vascular magnetic resonance imaging, pubVerDate Nov 24 2008 07:44 Dec 18, 2009 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4371.IH H4371

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1 lished in the rule referred to in clause (i), 

2 from taking effect on January 1, 2010. 

3 ‘‘(iv) STUDY AND REPORT ON PRAC4 TICE EXPENSE METHODOLOGY.—The Sec5 retary, in consultation with medical spe6 cialty society stakeholders and other af7 fected stakeholders, shall enter into a con8 tract with an independent entity— 

9 ‘‘(I) to conduct a study of the 

10 practice expense methodology used to 

11 determine relative value units under 

12 this paragraph to determine whether 

13 the cost finding, indirect cost alloca14 tion, scaling, and budget neutrality 

15 methodologies used are consistent 

16 with generally accepted accounting 

17 principles, distribute the burden of 

18 any necessary budget neutrality ad19 justments proportionally among all 

20 physicians’ services, comparison to 

21 other payment methodologies, and re22 sult in allowances that accurately re23 flect the relative direct and indirect 

24 resources involved in the provision of 

25 various physicians’ services; and 


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1 ‘‘(II) to submit to the Secretary 

2 and Congress no later than January 

3 1, 2011, a report on such study that 

4 includes recommendations for deter5 mining practice expense under this 

6 subsection. 

7 Upon completion of such study, the Sec8 retary may adjust the practice expense rel9 ative value units described in clause (i) and 

10 the codes described in clause (ii) for serv11 ices furnished on or after such date (not 

12 earlier than January 1, 2012) as the Sec13 retary may specify. 

14 ‘‘(v) NO BUDGET NEUTRALITY AD15 JUSTMENT.—The Secretary shall not make 

16 any reduction in relative value units or 

17 other budget neutrality adjustments pursu18 ant to the application of the previous pro19 visions of this subparagraph.’’. 

Æ 


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