There currently is no new modifier to bypass Medicare’s MPPR. Providers should continue to report modifier 59.
Modifier 59 is recommended by the CMS to bypass the application of a multiple procedure payment reduction when interpretations are given by the same physician for the same beneficiary, but are given in separate sessions.
In the 2013 Medicare Physician Fee Schedule Final Rule, CMS noted that they are considering creating a new modifier for the MPPR, but to date has not issued one. The ACR will be sure to release a notification once a new modifier is created and released by CMS.
A: Yes, the Centers for Medicare and Medicaid Services (CMS) has stated in the Medicare Physician Fee Schedule 2013 Final Rule that they will begin applying the MPPR to physicians in the same group practice as of Jan. 1, 2013. New in the 2013 Final Rule is the expansion of the MPPR policy to include imaging services furnished in the same session by physicians in the same group practice (same group National Provider Identifier). The MPPR will apply when one or more physicians in the same group practice furnishes services to the same beneficiary in the same session on the same day.
Please reference the Jan/Feb 2012 ACR Radiology Coding Source for additional information on the MPPR policy.