Cardiology Coding Alert

Question: I heard there was a change in the MPPR reduction. Does that apply to both the professional and technical components?

Illinois Subscriber

Answer: The change applies only to the professional component. Effective Jan. 1, 2017, Medicare is changing the Multiple Procedure Payment Reduction (MPPR) that applies to the professional component (PC) of certain diagnostic imaging codes that have a multiple surgery value of 4 in the Medicare Physician Fee Schedule.

2016: Currently, for the affected codes, Medicare pays the full value for the PC of the code with the highest payment. Then for each additional imaging procedure by the same physician (or group) for the same patient in the same session, Medicare pays 75 percent of the fee.

2017: Starting in 2017, Medicare will pay 95 percent of the fee, instead of 75 percent, for each additional procedure.

The MPPR on the technical component will still be 50 percent in 2017.

Examples of affected codes include cardiac MRI codes 75557-75563 and heart CT codes 75571-75574.

Resource: You can learn more at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9647.pdf.