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
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
Effective for claims processed with dates of service (DOS) on or after January 1, 2018, influenza virus vaccine code 90756 (Influenza v...
-
AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and held by more ...
-
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...