applicable percent
(4) (A) (i) In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians’ services furnished during the 15-month period beginning July 1, 1984 , the Secretary shall not set any level higher than the same level as was set for the 12-month period beginning July 1, 1983 . (ii) (I) In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians’ services furnished during the 8-month period beginning May 1, 1986 , by a physician who is not a participating physician (as defined in subsection (h)(1)) at the time of furnishing the services, the Secretary shall not set any level higher than the same level as was set for the 12-month period beginning July 1, 1983 . (II) In determining the prevailing charge levels under the fourth sentence of paragraph (3) for physicians’ services furnished during the 8-month period beginning May 1, 1986 , by a physician who is a participating physician (as defined in subsection (h)(1)) at the time of furnishing the services, the Secretary shall permit an additional one percentage point increase in the increase otherwise permitted under that sentence. (iii) In determining the maximum allowable prevailing charges which may be recognized consistent with the index described in the fourth sentence of paragraph (3) for physicians’ services furnished on or after January 1, 1987 , by participating physicians, the Secretary shall treat the maximum allowable prevailing charges recognized as of December 31, 1986 , under such sentence with respect to participating physicians as having been justified by economic changes. (iv) The reasonable charge for physicians’ services furnished on or after January 1, 1987 , and before January 1, 1992 , by a nonparticipating physician shall be no greater than the applicable percent of the prevailing charge levels established under the third and fourth sentences of paragraph (3) (or under any other applicable provision of law affecting the prevailing charge level). In the previous sentence, the term “applicable percent” means for services furnished (I) on or after January 1, 1987 , and before April 1, 1988 , 96 percent, (II) on or after April 1, 1988 , and before January 1, 1989 , 95.5 percent, and (III) on or after January 1, 1989 , 95 percent. (v) In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians’ services furnished during the 3-month period beginning January 1, 1988 , the Secretary shall not set any level higher than the same level as was set for the 12-month period beginning January 1, 1987 . (vi) Before each year (beginning with 1989), the Secretary shall establish a prevailing charge floor for primary care services (as defined in subsection (i)(4)) equal to 60 percent of the estimated average prevailing charge levels based on the best available data (determined, under the third and fourth sentences of paragraph (3) and under paragraph (4), without regard to this clause and without regard to physician specialty) for such service for all localities in the United States (weighted by the relative frequency of the service in each locality) for the year. (vii) Beginning with 1987, the percentage increase in the MEI (as defined in subsection (i)(3)) for each year shall be the same for nonparticipating physicians as for participating physicians. (B) (i) In determining the reasonable charge under paragraph (3) for physicians’ services furnished during the 15-month period beginning July 1, 1984 , the customary charges shall be the same customary charges as were recognized under this section for the 12-month period beginning July 1, 1983 . (ii) In determining the reasonable charge under paragraph (3) for physicians’ services furnished during the 8-month period beginning May 1, 1986 , by a physician who is not a participating physician (as defined in subsection (h)(1)) at the time of furnishing the services— (I) if the physician was not a participating physician at any time during the 12-month period beginning on October 1, 1984 , the customary charges shall be the same customary charges as were recognized under this section for the 12-month period beginning July 1, 1983 , and (II) if the physician was a participating physician at any time during the 12-month period beginning on October 1, 1984 , the physician’s customary charges shall be determined based upon the physician’s actual charges billed during the 12-month period ending on March 31, 1985 . (iii) In determining the reasonable charge under paragraph (3) for physicians’ services furnished during the 3-month period beginning January 1, 1988 , the customary charges shall be the same customary charges as were recognized under this section for the 12-month period beginning January 1, 1987 . (iv) In determining the reasonable charge under paragraph (3) for physicians’ services (other than primary care services, as defined in subsection (i)(4)) furnished during 1991, the customary charges shall be the same customary charges as were recognized under this section for the 9-month period beginning April 1, 1990 . In a case in which subparagraph (F) applies (relating to new physicians) so as to limit the customary charges of a physician during 1990 to a percent of prevailing charges, the previous sentence shall not prevent such limit on customary charges under such subparagraph from increasing in 1991 to a higher percent of such prevailing charges. (C) In determining the prevailing charge levels under the third and fourth sentences of paragraph (3) for physicians’ services furnished during periods beginning after September 30, 1985 , the Secretary shall treat the level as set under subparagraph (A)(i) as having fully provided for the economic changes which would have been taken into account but for the limitations contained in subparagraph (A)(i). (D) (i) In determining the customary charges for physicians’ services furnished during the 8-month period beginning May 1, 1986 , or the 12-month period beginning January 1, 1987 , by a physician who was not a participating physician (as defined in subsection (h)(1)) on September 30, 1985 , the Secretary shall not recognize increases in actual charges for services furnished during the 15-month period beginning on July 1, 1984 , above the level of the physician’s actual charges billed in the 3-month period ending on June 30, 1984 . (ii) In determining the customary charges for physicians’ services furnished during the 12-month period beginning January 1, 1987 , by a physician who is not a participating physician (as defined in subsection (h)(1)) on April 30, 1986 , the Secretary shall not recognize increases in actual charges for services furnished during the 7-month period beginning on October 1, 1985 , above the level of the physician’s actual charges billed during the 3-month period ending on June 30, 1984 . (iii) In determining the customary charges for physicians’ services furnished during the 12-month period beginning January 1, 1987 , or January 1, 1988 , by a physician who is not a participating physician (as defined in subsection (h)(1)) on December 31, 1986 , the Secretary shall not recognize increases in actual charges for services furnished during the 8-month period beginning on May 1, 1986 , above the level of the physician’s actual charges billed during the 3-month period ending on June 30, 1984 . (iv) In determining the customary charges for a physicians’ service furnished on or after January 1, 1988 , if a physician was a nonparticipating physician in a previous year (beginning with 1987), the Secretary shall not recognize any amount of such actual charges (for that service furnished during such previous year) that exceeds the maximum allowable actual charge for such service established under subsection (j)(1)(C). (E) (i) For purposes of this part for physicians’ services furnished in 1987, the percentage increase in the MEI is 3.2 percent. (ii) For purposes of this part for physicians’ services furnished in 1988, on or after April 1, the percentage increase in the MEI is— (I) 3.6 percent for primary care services (as defined in subsection (i)(4)), and (II) 1 percent for other physicians’ services. (iii) For purposes of this part for physicians’ services furnished in 1989, the percentage increase in the MEI is— (I) 3.0 percent for primary care services, and (II) 1 percent for other physicians’ services. (iv) For purposes of this part for items and services furnished in 1990, after March 31, 1990 , the percentage increase in the MEI is— (I) 0 percent for radiology services, for anesthesia services, and for other services specified in the list referred to in paragraph (14)(C)(i), (II) 2 percent for other services (other than primary care services), and (III) such percentage increase in the MEI (as defined in subsection (i)(3)) as would be otherwise determined for primary care services (as defined in subsection (i)(4)). (v) For purposes of this part for items and services furnished in 1991, the percentage increase in the MEI is— (I) 0 percent for services (other than primary care services), and (II) 2 percent for primary care services (as defined in subsection (i)(4)).