in the case of services described in section 1395k(a)(2) of this title (except those services described in subparagraphs (C), (D), (E), (F), (G), (H), and (I) of such section and unless otherwise specified in section 1395rr of this title )—
(A)#
with respect to home health services (other than a covered osteoporosis drug) (as defined in section 1395x(kk) of this title ), the amount determined under the prospective payment system under section 1395fff of this title ;
(B)#
with respect to other items and services (except those described in subparagraph (C), (D), or (E) of this paragraph and except as may be provided in section 1395ww of this title or section 1395yy(e)(9) of this title )—
(i) furnished before January 1, 1999 , the lesser of— (I) the reasonable cost of such services, as determined under section 1395x(v) of this title , or (II) the customary charges with respect to such services,
less the amount a provider may charge as described in clause (ii) of section 1395cc(a)(2)(A) of this title , but in no case may the payment for such other services exceed 80 percent of such reasonable cost, or
(ii) if such services are furnished before January 1, 1999 , by a public provider of services, or by another provider which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low-income (and requests that payment be made under this clause), free of charge or at nominal charges to the public, 80 percent of the amount determined in accordance with section 1395f(b)(2) of this title , or
(iii) if such services are furnished on or after January 1, 1999 , the amount determined under subsection (t), or
(iv) if (and for so long as) the conditions described in section 1395f(b)(3) of this title are met, the amounts determined under the reimbursement system described in such section;
(B)(i)#
furnished before January 1, 1999 , the lesser of—
(I) the reasonable cost of such services, as determined under section 1395x(v) of this title , or
(II) the customary charges with respect to such services,
(B)(i)(I)#
(C)#
with respect to services described in the second sentence of section 1395x(p) of this title , 80 percent of the reasonable charges for such services;
(D)#
with respect to clinical diagnostic laboratory tests for which payment is made under this part (i)(I) on the basis of a fee schedule determined under subsection (h)(1) (for tests furnished before January 1, 2017 ) or subsection (d)(1) or (aa) of section 1395m of this title , the amount paid shall be equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on an assignment-related basis or to a provider having an agreement under section 1395cc of this title ) of the lesser of the amount determined under such fee schedule, the limitation amount for that test determined under subsection (h)(4)(B), or the amount of the charges billed for the tests, or (II) under section 1395m–1 of this title (for tests furnished on or after January 1, 2017 ), the amount paid shall be equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on an assignment-related basis or to a provider having an agreement under section 1395cc of this title ) of the lesser of the amount determined under such section or the amount of the charges billed for the tests, or (ii) for tests furnished before January 1, 2017 , on the basis of a negotiated rate established under subsection (h)(6), the amount paid shall be equal to 100 percent of such negotiated rate for such tests;
(E)#
with respect to—
(i) outpatient hospital radiology services (including diagnostic and therapeutic radiology, nuclear medicine and CAT scan procedures, magnetic resonance imaging, and ultrasound and other imaging services, but excluding screening mammography and, for services furnished on or after January 1, 2005 , diagnostic mammography), and
(ii) effective for procedures performed on or after October 1, 1989 , diagnostic procedures (as defined by the Secretary) described in section 1395x(s)(3) of this title (other than diagnostic x-ray tests and diagnostic laboratory tests),
the amount determined under subsection (n) or, for services or procedures performed on or after January 1, 1999 , subsection (t);
(E)(i)#
outpatient hospital radiology services (including diagnostic and therapeutic radiology, nuclear medicine and CAT scan procedures, magnetic resonance imaging, and ultrasound and other imaging services, but excluding screening mammography and, for services furnished on or after January 1, 2005 , diagnostic mammography), and
(E)(ii)#
effective for procedures performed on or after October 1, 1989 , diagnostic procedures (as defined by the Secretary) described in section 1395x(s)(3) of this title (other than diagnostic x-ray tests and diagnostic laboratory tests),
(F)#
with respect to a covered osteoporosis drug (as defined in section 1395x(kk) of this title ) furnished by a home health agency, 80 percent of the reasonable cost of such service, as determined under section 1395x(v) of this title ;
(G)#
with respect to items and services described in section 1395x(s)(10)(A) of this title , the lesser of—
(i) the reasonable cost of such services, as determined under section 1395x(v) of this title , or
(ii) the customary charges with respect to such services; and
(G)(i)#
the reasonable cost of such services, as determined under section 1395x(v) of this title , or
(G)(ii)#
the customary charges with respect to such services; and
(H)#
or, 4 4 See 2010 Amendment note for subsec. (a)(2)(F) to (H) below. if such services are furnished by a public provider of services, or by another provider which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low-income (and requests that payment be made under this provision), free of charge or at nominal charges to the public, the amount determined in accordance with section 1395f(b)(2) of this title ;