limiting charge
(2) “Limiting charge” defined (A) For 1991 For physicians’ services of a physician furnished during 1991, other than radiologist services subject to section 1395m(b) of this title , the “limiting charge” shall be the same percentage (or, if less, 25 percent) above the recognized payment amount under this part with respect to the physician (as a nonparticipating physician) as the percentage by which— (i) the maximum allowable actual charge (as determined under section 1395u(j)(1)(C) of this title as of December 31, 1990 , or, if less, the maximum actual charge otherwise permitted for the service under this part as of such date) for the service of the physician, exceeds (ii) the recognized payment amount for the service of the physician (as a nonparticipating physician) as of such date. In the case of evaluation and management services (as specified in section 1395u(b)(16)(B)(ii) of this title ), the preceding sentence shall be applied by substituting “40 percent” for “25 percent”. (B) For 1992 For physicians’ services furnished during 1992, other than radiologist services subject to section 1395m(b) of this title , the “limiting charge” shall be the same percentage (or, if less, 20 percent) above the recognized payment amount under this part for nonparticipating physicians as the percentage by which— (i) the limiting charge (as determined under subparagraph (A) as of December 31, 1991 ) for the service, exceeds (ii) the recognized payment amount for the service for nonparticipating physicians as of such date. (C) After 1992 For physicians’ services furnished in a year after 1992, the “limiting charge” shall be 115 percent of the recognized payment amount under this part for nonparticipating physicians or for nonparticipating suppliers or other persons. (D) Recognized payment amount In this section, the term “recognized payment amount” means, for services furnished on or after January 1, 1992 , the fee schedule amount determined under subsection (a) (or, if payment under this part is made on a basis other than the fee schedule under this section, 95 percent of the other payment basis), and, for services furnished during 1991, the applicable percentage (as defined in section 1395u(b)(4)(A)(iv) of this title ) of the prevailing charge (or fee schedule amount) for nonparticipating physicians for that year.