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. GRAY-
SON, 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 DIAZ- 
BALART 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 de-
termined 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. 
VerDate Nov 24 2008 
07:44 Dec 18, 2009
Jkt 089200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H4371.IH
H4371
erowe on DSK5CLS3C1PROD with BILLS
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. CONTINUED USE OF 2009 MEDICARE PRACTICE 
EXPENSE RELATIVE VALUE UNITS FOR CER-
TAIN CARDIOLOGY SERVICES. 
Section 1848(c)(2) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)) is amended by adding at the end 
the following new subparagraph: 
‘‘(K) CONTINUED USE OF 2009 PRACTICE 
EXPENSE RELATIVE VALUE UNITS FOR CERTAIN 
CARDIOLOGY SERVICES.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of law, including provi-
sions contained in the final rule published 
in the Federal Register on November 25, 
2009 (74 Fed. Reg. 61737), relating to CY 
2010 relative value units, subject to clause 
(iii) and the second sentence of clause (iv), 
in determining the practice expense pay-
ment under this paragraph for services 
performed predominantly by cardiologists 
and furnished on or after January 1, 2010, 
the Secretary shall continue practice ex-
pense relative value units at the levels for 
CY 2009 for such services. For purposes of 
VerDate Nov 24 2008 
07:44 Dec 18, 2009
Jkt 089200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4371.IH
H4371
erowe on DSK5CLS3C1PROD with BILLS
the previous sentence, the services per-
formed predominantly by cardiologists in-
clude (as determined by the Secretary) car-
diac monitoring services, services per-
formed primarily for the diagnosis or treat-
ment of heart disease, and other services 
at least 50 percent of which are performed 
under this part by cardiologists. 
‘‘(ii) INCLUSION OF SPECIFIC CARDIAC 
CODES.—In determining practice expense 
relative value units under this paragraph 
for myocardial perfusion imaging (CPT 
codes 78451–78454) for services furnished 
on or after January 1, 2010, subject to 
clause (iii) and the second sentence of 
clause (iv), the Secretary shall use the 
2009 practice expense relative value units 
for the previous codes that were combined 
to create such CPT codes. 
‘‘(iii) NEW CPT CODE IMPLEMENTA-
TION PERMITTED.—Nothing in clause (i) 
or (ii) shall be construed to prevent new 
category I CPT codes related to cardio-
vascular computed tomography and cardio-
vascular magnetic resonance imaging, pub-
VerDate Nov 24 2008 
07:44 Dec 18, 2009
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4371.IH
H4371
erowe on DSK5CLS3C1PROD with BILLS
lished in the rule referred to in clause (i), 
from taking effect on January 1, 2010. 
‘‘(iv) STUDY AND REPORT ON PRAC-
TICE EXPENSE METHODOLOGY.—The Sec-
retary, in consultation with medical spe-
cialty society stakeholders and other af-
fected stakeholders, shall enter into a con-
tract with an independent entity— 
‘‘(I) to conduct a study of the 
practice expense methodology used to 
determine relative value units under 
this paragraph to determine whether 
the cost finding, indirect cost alloca-
tion, scaling, and budget neutrality 
methodologies used are consistent 
with generally accepted accounting 
principles, distribute the burden of 
any necessary budget neutrality ad-
justments proportionally among all 
physicians’ services, comparison to 
other payment methodologies, and re-
sult in allowances that accurately re-
flect the relative direct and indirect 
resources involved in the provision of 
various physicians’ services; and 
VerDate Nov 24 2008 
07:44 Dec 18, 2009
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4371.IH
H4371
erowe on DSK5CLS3C1PROD with BILLS