applicable percentage

(ii)For purposes of clause (i), the term “applicable percentage” means a percentage specified by the Secretary up to (but not to exceed)— (I)for a year (or portion of a year) before 2004, 2.5 percent; and (II)for 2004 and thereafter, 3.0 percent. (D)In applying subparagraph (A) for covered OPD services furnished before, the Secretary may— (i)apply such subparagraph to a bill for such services related to an outpatient encounter (rather than for a specific service or group of services) using OPD fee schedule amounts and transitional pass-through payments covered under the bill; and (ii)use an appropriate cost-to-charge ratio for the hospital involved (as determined by the Secretary), rather than for specific departments within the hospital. (E)No additional payment shall be made under subparagraph (A) in the case of ambulatory payment classification groups established separately for drugs or biologicals.


42 USC § 1395l(t)()(5)(C)(ii)

Scoping language

None: Default is title Scope
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