August 31, 2016

CMS to Change MPPR Reduction in 2017

With the strong advocacy by the ACR, the Consolidated Appropriations Act of 2016 was passed, which decreases the Multiple Procedure Payment Reduction (MPPR) for the professional component (PC) of covered services from 25% to 5% of the Medicare Physician Fee Schedule (MPFS) payment rate. Many services covered by the Centers for Medicare and Medicaid Services (CMS) are time-based with the potential for multiple units being billed for the same procedure. The MPPR is a payment reduction imposed by CMS when more than one procedure or unit is provided to the same patient on the same day for certain diagnostic imaging services. Currently, CMS provides full payment for the PC of the highest-paid procedure and pays only 75% of each additional procedure when furnished by the same physician or group in the same session on the same day. Effective January 1, 2017 Medicare Administrative Contractors (MACs) will pay 95% of the MPFS payment rate for the PC of second and subsequent procedures provided by the same physician or group in the same session on the same day.

For more information please see MLN Matters Article MM9647.

Please contact Dominick Parris in the Department of Economics and Health Policy with your questions.