IB 
Union Calendar No. 585 
115TH CONGRESS 
2D SESSION 
H. R. 5804 
[Report No. 115–752, Part I] 
To amend title XVIII of the Social Security Act to provide for modifications 
in payment for certain outpatient surgical services. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mr. SHIMKUS (for himself, Mr. KRISHNAMOORTHI, and Mr. ROSKAM) intro-
duced 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 
JUNE 13, 2018 
Additional sponsor: Mr. WALDEN 
JUNE 13, 2018 
Reported from the Committee on Energy and Commerce 
JUNE 13, 2018 
Committee on Ways and Means discharged; committed to the Committee of 
the Whole House on the State of the Union and ordered to be printed 
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A BILL 
To amend title XVIII of the Social Security Act to provide 
for modifications in payment for certain outpatient sur-
gical services. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Post-Surgical Injec-
tions as an Opioid Alternative Act’’. 
SEC. 2. MODIFICATION OF PAYMENT FOR CERTAIN OUT-
PATIENT SURGICAL SERVICES. 
(a) FREEZE OF PAYMENT FOR CERTAIN SERVICES 
FURNISHED IN AMBULATORY SURGICAL CENTERS.—Sec-
tion 1833(i)(2) of the Social Security Act (42 U.S.C. 
1395l(i)(2)) is amended by adding at the end the following 
new subparagraph: 
‘‘(F)(i) With respect to a targeted procedure 
(as defined in clause (ii)) furnished during 2020 or 
a subsequent year (before 2025) to an individual in 
an ambulatory surgical center, the payment amount 
for such procedure that would otherwise be deter-
mined under the revised payment system under sub-
paragraph (D), without application of this subpara-
graph, shall be equal to the payment amount for 
such procedure furnished in 2016. 
‘‘(ii) For purposes of clause (i), the term ‘tar-
geted procedure’ means a procedure to which 
Healthcare Common Procedure Coding System 
62310 (or, for years beginning after 2016, 62321), 
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62311 (or, for years beginning after 2016, 62323), 
62264, 64490, 64493, or G0260 (or any successor 
code) applies. 
‘‘(iii) This subparagraph shall not be applied in 
a budget-neutral manner.’’. 
(b) DATA COLLECTION.— 
(1) IN
GENERAL.—The Comptroller General 
shall collect data relating to the cost differential be-
tween targeted procedures (as defined in section 
1833(i)(2)(F)(ii) of the Social Security Act, as 
added by subsection (a)) that are performed in a 
hospital operating room and such procedures that 
are performed in an office setting within a hospital 
in order to determine whether such procedures are 
being properly coded for claims, based on setting, for 
payment under section 1833(i)(2)(D) of the Social 
Security Act (42 U.S.C. 1395l(i)(2)(D)) and to de-
termine if further changes are needed in the classi-
fication system for covered outpatient department 
services (as described in section 1833(t)(2)(A) of the 
Social Security Act (42 U.S.C. 1395l(t)(2)(A)). 
(2) REPORT.—Not later than 4 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit a report to the Committee on 
Energy and Commerce and the Committee on Ways 
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and Means of the House of Representatives and the 
Committee on Finance of the Senate containing— 
(A) a determination of whether procedures 
described in paragraph (1) are being properly 
coded for claims, based on setting, for payment 
under section 1833(i)(2)(D) of the Social Secu-
rity Act (42 U.S.C. 1395l(i)(2)(D)); and 
(B) recommendations on any changes the 
Comptroller General determines are needed in 
the classification system for covered outpatient 
department services (as described in section 
1833(t)(2)(A) of the Social Security Act (42 
U.S.C. 1395l(t)(2)(A)). 
(c) STUDY.—Not later than 3 years after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall conduct a study and submit to Con-
gress a report on the extent to which procedures described 
in section 1833(i)(2)(F)(ii) of the Social Security Act, as 
added by subsection (a), are effective at preventing the 
need for opioids for individuals furnished such procedures. 
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Union Calendar No. 585 
115TH CONGRESS 
2D SESSION 
H. R. 5804 
[Report No. 115–752, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
provide for modifications in payment for certain 
outpatient surgical services. 
JUNE 13, 2018 
Reported from the Committee on Energy and Commerce 
JUNE 13, 2018 
Committee on Ways and Means discharged; committed to 
the Committee of the Whole House on the State of the 
Union and ordered to be printed 
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