Beginning January 1, 2013, physicians in the same practice group who provide certain diagnostic imaging services may be required to bill at reduced rates, due to a broadened application of the Multiple Procedure Payment Reduction (MPPR). CMS stated this new policy in Transmittal 7747, which originally was issued on August 2, 2012, and recently was re-communicated as the effective date grew closer.

Prior to the new policy, the MPPR applied only when an individual physician furnished multiple services to the same patient, in the same session, on the same day. However, under the new policy, the MPPR is expanded and applies to physicians in the same group practice (i.e., same Group National Provider Identifier) who furnish multiple services to the same patient, in the same session, on the same day.

The MPPR on certain diagnostic imaging services applies to both Professional Component (PC) and Technical Component (TC) services. In particular, the MPPR applies to PC-only services, TC-only services, and to the PC and TC of global services. Under the new policy, after full payment is made for each PC and TC service with the highest payment under the Medicare Physician Fee Schedules (MPFS), CMS will pay at 75 percent for subsequent PC services furnished by a physician in the same group practice to the same patient in the same session on the same day. Payment then will be made at 50 percent for subsequent TC services furnished by a physician in the same group practice to the same patient in the same session on the same day. 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.

Additionally, beginning January 1, 2013, CMS will assume procedures furnished on the same date of service were furnished in the same session unless the provider uses modifier 59 to indicate multiple sessions, in which case the reduction will not apply.

Transmittal 7747, which includes a complete list of codes subject to the MPPR on diagnostic imaging, is available by clicking here.

Reporter, Ramsey Prather, Atlanta, +1 404 572 4624, rprather@kslaw.com.