Wiki Multiple Procedure Payment Reduction

[Jm_2013@Comcast.net]

Does anyone have a link to written documentation regarding multiple procedure payment reduction for surgeries 3-5 performed same day being reduced to 25% of the fee schedule? I am struggling to find documentation I can provide to my provider who is questioning if this is accurate reduction.

Thank you in advance!

 

[thomas7331]

Multiple procedure reductions depend on specific payers' policies and contracts with providers - there is no single document you can point to that will tell you what amount of reduction is used across the board. Medicare no longer reduces any multiple procedures to 25%, but I believe there are still Medicaid plans in some states and possibly some commercial payers out there that still do that. You'd have to review each payer's policy and look at your provider's contracts to see whether or not that is the case in your situation.