PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 365 colonoscopy services furnished on or after January 1, 1999, that are performed in an ambulatory surgical center or a hospital outpatient department, payment under this part shall be based on the lesser of the amount under the fee schedule that would apply to such services if they were performed in a hospital outpatient department in an area or the amount under the fee schedule that would apply to such services if they were performed in an ambulatory surgical center in the same area. "(ii) LIMITATION ON DEDUCTIBLE AND COINSUR- ANCE. —Notwithstanding any other provision of this title, in the case of a beneficiary who receives the services described in clause (i)— "(I) in computing the amount of any applicable deductible or coinsurance, the computation of such deductible or coinsurance shall be based upon the fee schedule under which payment is made for the services, and "(II) the amount of such coinsurance is equal to 25 percent of the payment amount under the fee schedule described in subclause (I). "(D) SPECIAL RULE FOR DETECTED LESIONS. —If during the course of such screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the lesion or growth, payment under this part shall not be made for the screening colonoscopy but shall be made for the procedure classified as a colonoscopy with such biopsy or removal. "(E) FREQUENCY LIMIT.—N O payment may be made under this part for a colorectal cancer screening test consisting of a screening colonoscopy for individuals at high risk for colorectal cancer if the procedure is performed within the 23 months after a previous screening colonoscopy.". (c) CONFORMING AMENDMENTS.—(1) Paragraphs (1)(D) and (2)(D) of section 1833(a) (42 U.S.C. 13951(a)) are each amended by inserting "or section 1834(d)(1)" after "subsection (h)(1)". (2) Section 1833(h)(1)(A) (42 U.S.C. 13951(h)(1)(A)) is amended by striking "The Secretary" and inserting "Subject to section 1834(d)(1), the Secretary". (3) Section 1862(a) (42 U.S.C. 1395y(a)), as amended by section 4103(c), is amended— (A) in paragraph (1)— (i) in subparagraph (F), by striking "and" at the end, (ii) in subparagraph (G), by striking the semicolon at the end and inserting ", and", and (iii) by adding at the end the following new subparagraph: "(H) in the case of colorectal cancer screening tests, which are performed more fi*equently than is covered under section 1834(d);"; and (B) in paragraph (7), by striking "or (G)" and inserting "(G), or (H)". (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.—Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)), as amended by sections 4102 and 4103, is amended by inserting "(2)(R) (with respect to services
�
