; (2) in item (aa), as inserted by subparagraph (A), by striking $20,000,000 and inserting the amount specified in item (bb) for such year ; and (3) by adding at the end the following new items: (bb) Amount specified For purposes of item (aa), subject to item (cc), the amount specified in this item is— (AA) for years before 2025, $20,000,000; (BB) for 2025, $53,000,000; and (CC) for 2026 and each subsequent year, the amount specified in this item for the preceding year. (cc) Indexing limitation on annual adjustments For 2030 and every subsequent fifth year, the Secretary shall increase the amount specified in item (bb) for such year by the cumulative increase in the MEI (as defined in section 1842(i)(3)) applicable to physicians’ services over the 5-year period ending on the last day of the preceding year. . 6. Timely updates to direct costs used to calculate practice expense RVUs Section 1848(c)(2)(B) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B) ) is amended by adding at the end the following new clause: (vii) Timely updates to direct costs used to calculate practice expense relative value units (I) Simultaneous updates to direct cost inputs at least once every 5 years The Secretary shall, not less often than every 5 years, update the prices and rates, as applicable, for each of the direct costs inputs described in subclause (II) used in the methodology for calculating the practice expense relative value units under this subsection for physicians’ services. Updates made pursuant to the previous sentence shall be made in the same year for all direct cost inputs described in such subclause. (II) Direct costs input categories described For purposes of this clause, the direct costs inputs described in this subclause are clinical staff wage rates, prices of medical supplies, and prices of equipment. (III) Consultation In making the updates under this clause, the Secretary shall consult with relevant stakeholders, including physician specialty societies. .