Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures - JE Part B
Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures
The Multiple Procedure Payment Reduction (MPPR) on certain diagnostic imaging applies when multiple services are furnished by the same physician to the same patient in the same session on the same day.
Section 502(a)(2) of the Consolidated Appropriations Act of 2016 revised the MPPR for the professional component (PC) of the second and subsequent procedures from 25 percent to five percent of the physician fee schedule amount. The MPPR on the technical component (TC) remains at 50 percent.
The MPPR includes the professional component (PC) and technical component (TC) to physicians in the same group practice (same Group National Provider Identifier) who furnish multiple services to the same patient, in the same session, on the same day.
The MPPR applies to PC and TC services, PC-only services, and the PC portion of global services, for the procedures with a multiple surgery value of ‘4’ in the Medicare Fee Schedule database.
Payment
Prior to January 1, 2017, full payment was made for the PC of the highest-priced procedure and 75 percent for the PC of each additional procedure when furnished by the same physician (or physician in the same group practice) to the same patient, in the same session on the same day.
Effective January 1, 2017, full payment is made for the PC of the highest-priced procedure and 95 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.
| Modifier | Procedure 1 | Procedure 2 | Total Payment |
|---|---|---|---|
| PC or 26 | $100 | $80 | $176 ($100 + (.95 X $80)) |
| TC | $500 | $400 | $700 ($500 + (.50 X $400)) |
| Global | $600 | $480 | $876 ($600 + (.95 X $80)) + (.50 X $400)) |
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