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(vi) includes, with respect to a year (beginning with 2027), any item or service—(I) that is furnished during such year by an off-campus outpatient department of a provider (as defined in subparagraph (B) of paragraph (21)); and(II) with respect to which the greatest total amount paid with respect to a physician specialty under the physician fee schedule under section 1848 for all such items or services furnished by physicians in such specialty during the previous year was less than $2,000,000.