Practice Management Alert

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?

California 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 some payers).

Important: Even if the payer you are billing follows a multiple procedure reduction policy, you should not reduce the fee before you send your claim. Let the payer reduce the fee. You don't want to reduce your fee and then have the payer reduce it again.

Hint: If you need to apply modifier 51 (Multiple procedures) to a surgical code, then you'll be facing multiple procedure fee reductions. Keep in mind, however, that electronic claims processing allows many payers to recognize multiple procedures in one session without the modifier. For example, Medicare automatically appends modifier 51. Contact your payer to find out whether or not to append 51.