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Medical Coding News Archives

The Multiple Procedure Payment Reduction Has Expanded

 
January 19, 2012:

Nichole VanHorn, Clinical/Technical Editor

Physicians, clinical diagnostic laboratories, and other providers who provide services to Medicare beneficiaries should note that the multiple procedure payment reduction (MPPR) has been expanded to include the professional component (PC), in addition to the technical component (TC), of certain diagnostic imaging procedures.

When a physician performs multiple services for the same patient, in the same session, on the same date of service, the MPPR on diagnostic imaging applies. At this time, the MPPR on diagnostic imaging services applies only to the TC services (TC-only services and to the TC portion of global services). Full payment is made for the service with the highest TC payment; subsequent services are paid at 50 percent when performed by the same physician, to the same patient, in the same session, on the same date of service.

Under the Centers for Medicare and Medicaid Services’ new policy the MPPR will expand to PC services. Full payment will be made for each PC and TC service with the highest payment under the Medicare physician fee schedule (MPFS). For subsequent services payment is made at 75 percent for PC services and 50 percent for TC services furnished by the same physician, to the same patient, in the same session, on the same date of service. At the present time, CMS will not be applying the imaging MPPR to group practices.

Providers should append modifier 51 to subsequent services to indicate that multiple procedures were performed.

A complete list of codes subject to the MPPR on diagnostic imaging policy can be found in attachment 1 of CR 7442, on the CMS website.

 

 
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