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Orthopedic Coding Alert

Reader questions:

Let payers reduce your multiple procedure fees

Published on Sat Nov 28, 2009

Question: Are insurance companies allowed to reduce our fees for multiple procedures performed during the same session? If so, should I be reducing the fee before sending the claim? New Jersey Subscriber Answer: Many payers, including Medicare, follow a reduced fee policy for multiple procedures performed during the same operative session. Generally, the policy looks something like this: • Procedure 1 is paid at 100 percent of the allowable • Procedure 2 is paid at 50 percent of the allowable • Procedure 3 is paid at 25 percent of the allowable (for some payers) and 50 percent of the allowable (for other payers, such as Medicare). Important: Even if the payer in question follows a multiple procedure reduction policy, you should not reduce the fee before you send your claim. Let the payer reduce the fee -- that way you don't risk reducing the fee yourself and then having the payer [...]
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