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The methodology for excluding payment amounts for HCPCS and CPT codes exhibiting SAHS billing activity, as described in section III.G.7.d of this final rule, is anticipated to be utilized only in rare and extreme cases where a number of criteria are satisfied, including that the level of billing represents a significant claims increase representing a deviation from historical utilization trends that is unexpected and not clearly attributable to reasonably explained changes in policy or the supply or demand for covered items or services during a limited time period

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33 GottiC.MorettiM.ClementiF.RigantiL.McIntoshJ.CollinsA.et al (2005)

On the other hand, it must be stressed that the above values are averages and there might be significant spatial heterogeneity 57

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