Medicare MPPR (Multiple Procedure Payment Reduction)

Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures

Effective January 1, 2012 CMS is expanding the MPPR by applying it to PC services. Currently, the MPPR on diagnostic imaging services applies only the TC services. Full payment is made for each PC and TC service with the highest payment under the Medicare Physician Fee Schedule (MPFS). Payment is made at 75 percent for subsequent PC services furnished by the same physician to the same patient in the same session on the same day. Payment is made at 50 percent for subsequent TC services furnished by the same physician to the same patient in the same session on the same day. Due to operational considerations, CMS is not applying the imaging MPPR to group practices at this time.

The individual PC and TC services with the highest payments under the MPFS of globally billed services must be determined in order to calculate the reduction.When applying the reduction, Medicare contractors will use modifier 51 to identify reduced PC services and reduced global services as they do today for TC services. In addition, they will append Claim Adjustment Reason Code 59 (Processed based on multiple or concurrent procedure rules).

Please see the complete list of codes subject to the MPPR on diagnostic imaging

Reference:

http://www.cms.gov/MLNMattersArticles/downloads/MM7442.pdf