We have long been used to payment reductions when multiple surgical procedures are performed at the same session. No one likes it, but a 50% reduction on the second and each subsequent procedure has become the norm. Medicare applies a similar reduction to some diagnostic tests, although it isn’t as drastic. This is known as the multiple procedure payment reduction (MPPR). It isn’t new, but many providers are unaware that MPPR is taking place.

Q. What is Medicare’s multiple procedure payment reduction?

A. CMS believes that many services have overlapping components, so Medicare is attempting to avoid “duplication of payment” when multiple images of contiguous body parts are taken in a single session. The solution to “duplication of payment” is a reduction in payment for the technical component of the service. The professional component payment is not affected by the rule.

The background of the MPPR is found on the CMS website fact sheet, “Proposed Changes for Payment for Imaging Services Under the Physician Fee Schedule Required by the Deficit Reduction Act.”¹ The article explains, “The Medicare Physician Fee Schedule (MPFS) proposed rule for 2007 includes proposals to implement two provisions of the Deficit Reduction Act of 2005 (DRA) affecting payment for imaging services under the fee schedule. The first provision addresses payment for certain multiple imaging procedures, with full payment for the first procedure, but a 25 percent reduction in payment for additional imaging procedures furnished on contiguous body parts during the same session.”

Since 2013, Medicare has reduced the technical component of second and subsequent ophthalmic tests by 20% when more than one eligible diagnostic test is performed on the same day. The professional component of the test is paid in full for each test. Thus, if you perform fundus photography (92250) and fluorescein angiography (92235) on the same day, the technical component of photography will be reduced by 20%, or about $4.

Q. What tests are subject to the MPPR?

A. The list of tests subject to the MPPR includes tests common in a retina clinic: ultrasound, imaging, and visual fields. I’ve listed the tests affected by the MPPR in Table 1 (MPFS “Multiple Procedure Indicator” identifies these codes annually with the multiple procedure indicator 7). Any test that does not have a technical component, such as extended ophthalmoscopy (92201, 92202), is not subject to the MPPR.

Things can become confusing when one test is bilateral and another unilateral, such as B-scan performed in both eyes (unilateral test payment) and fundus photography in both eyes (bilateral test payment). One B-scan is paid in full, while the second B-scan and the photos are subject to the 20% technical component reduction, or about $8 total.

Q. Is there anything we can do about this?

A. Although you could avoid the reduction by scheduling testing on different dates of service, this is generally not a viable strategy. Costs associated with bringing the patient back far exceed the MPPR reduction. Also, a pattern of such billing would likely attract unwanted attention and could be seen as abusive by Medicare. RP

REFERENCE

1. Centers for Medicare and Medicaid Services. Proposed changes for payment for imaging services under the physician fee schedule required by the Deficit Reduction Act (DRA). August 8, 2006. Accessed November 23, 2021. https://www.cms.gov/newsroom/fact-sheets/proposed-changes-payment-imaging-services-under-physician-fee-schedule-required-deficit-reduction