Wiki Medicare Multiple Procedures Reduction Rule and How it applies to facility billing

[stacyciccone]

Hoping to get some clarification - Does the Medicare Multiple Procedures Rule apply to facilities (billing for the facility - Ambulatory Surgical Centers, Outpatient Hospital Surgeries) or is it just for the Providers? Hoping to get specific answer to this. Thank you!

 

[sls314]

Hoping to get some clarification - Does the Medicare Multiple Procedures Rule apply to facilities (billing for the facility - Ambulatory Surgical Centers, Outpatient Hospital Surgeries) or is it just for the Providers? Hoping to get specific answer to this. Thank you!

Outpatient hospital facilities get paid under OPPS. CMS has a status indicator assigned to each code to show how processing would be affected. Example - a status indicator of N means that it is a packaged service that does not get paid separately.

Status indicator T indicates codes where there would be a multiple procedure reduction for an outpatient hospital facility.

Services with status indicator T are paid separately under OPPS but a multiple procedure payment reduction applies when two or more services with a status indicator of T are billed on the same date of service.

The first code with a Status T indicator would be paid at 100% of OPPS. All subsequent codes with a Status T indicator get paid at 50% of the OPPS rate.

 

[stacyciccone]

Outpatient hospital facilities get paid under OPPS. CMS has a status indicator assigned to each code to show how processing would be affected. Example - a status indicator of N means that it is a packaged service that does not get paid separately.

Status indicator T indicates codes where there would be a multiple procedure reduction for an outpatient hospital facility.

Services with status indicator T are paid separately under OPPS but a multiple procedure payment reduction applies when two or more services with a status indicator of T are billed on the same date of service.

The first code with a Status T indicator would be paid at 100% of OPPS. All subsequent codes with a Status T indicator get paid at 50% of the OPPS rate.

Thank you So much Susan!!

 

[sls314]

Thank you So much Susan!!

You're welcome.

Also, CMS Appendix B lists the status indicators for all codes that are payable under OPPS.

You can find it on the link below - it is updated quarterly.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates

 

[stacyciccone]

You're welcome.

Also, CMS Appendix B lists the status indicators for all codes that are payable under OPPS.

You can find it on the link below - it is updated quarterly.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates

Thank you again!! You made me look good and I learned something new