103 STAT. 2172 PUBLIC LAW 101-239—DEC. 19, 1989 "(A) IN GENERAL. — "(i) COMBINATION OF UNITS FOR COMPONENTS. — The Secretary shall develop a methodology for combining the work, practice expense, and malpractice relative value units, determined under subparagraph (C), for each service in a manner to produce a single relative value for that service. "(ii) EXTRAPOLATION. — The Secretary may use extrapolation and other techniques to determine the number of relative value units for physicians' services for which specific data are not available and shall take into account recommendations of the Physician Pay- ment Review Commission and the results of consulta- tions with organizations representing physicians who provide such services. " (B) PERIODIC REVIEW AND ADJUSTMENTS IN RELATIVE VALUES. — "(i) PERIODIC REVIEW.— The Secretary, not less often than every 5 years, shall review the relative values established under this paragraph for all physicians' services, " (ii) ADJUSTMENTS.— "(I) IN GENERAL.— The Secretary shall, to the extent the Secretary determines to be necessary and subject to subclause (II), adjust the number of such units to take into account changes in medical practice, coding changes, new data on relative value components, or the addition of new proce- dures. The Secretary shall publish an explanation of the basis for such adjustments. "(II) LIMITATION ON ANNUAL ADJUSTMENTS. —The adjustments under subclause (I) for a year may not cause the amount of expenditures under this part for the year to differ by more than $20,000,000 from the amount of expenditures under this part that would have been made if such adjustments had not been made, "(iii) CONSULTATION. — The Secretary, in making a4justments under clause (ii), shall consult with the Physician Payment Review Commission and organiza- tions representing physicians. "(C) COMPUTATION OF RELATIVE VALUE UNITS FOR COMPO- NENTS. —For purposes of this section for each physicians' service— "(i) WORK RELATIVE VALUE UNITS.— The Secretary shall determine a number of work relative value units for the service based on the relative resources incor- porating physician time and intensity required in fur- nishing the service. "(ii) PRACTICE EXPENSE RELATIVE VALUE UNITS. —The Secretary shall determine a number of practice ex- pense relative value units equal to the product of— "(I) the base allowed charges (as defined in subparagraph (D)) for the service, and "(II) the practice expense percentage for the service (as determined under paragraph (3)(C)(ii)).
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