How the Multiple Procedure Payment Reduction Policy affects your practice

By Walt Whitley, O.D., Jason Miller, O.D., and Chuck Brownlow, O.D.

Over the past few weeks, we've covered changes that will affect your practice in 2014, including updated HIPAA regulations and the coming shift from ICD-9 to ICD-10.

Add another item to the list of need-to-know changes: the Multiple Procedure Payment Reduction Policy (MPPR).

MPPR mainly affects special ophthalmological diagnostic services.

This Medicare policy went into effect Jan. 1, 2013. But your understanding of MPPR is increasingly important as Medicare and the Department of Health & Human Services (HHS) Office of Inspector General work to ensure compliance.

Authorized under the Affordable Care Act, MPPR affects the technical component of several eye procedures. This policy specifies that the Secretary of Health & Human Services identify potentially mis-valued codes by examining multiple codes frequently billed in conjunction with a single service.

The effects of MPPR

MPPR mainly affects special ophthalmological diagnostic services. You can find a full list of procedures subject to MPPR online, but they include:

  • Fundus photography (92250),
  • Scanning computerized ophthalmic diagnostic imaging (92132, 92133, 92134),
  • Ophthalmic ultrasound, diagnostic (76514), and
  • Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation (92136).

The MPPR will be applied when you provide multiple services to the same patient on the same day. These reductions apply only to the technical component of global services-not the professional component.

When your practice provides multiple ophthalmic imaging services to the same patient on the same day, the most expensive service will be paid at the normal Medicare physician fee schedule rate. The technical component of the other services will be paid at 80 percent of the fee schedule. Practitioners will receive a Claim Adjustment Reason Code of 59 on the remittance advice when these payments are reduced.

Do you have a coding or billing question of your own? Ask the Codeheads.

January 10, 2014

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