Radiology Coding Alert

Question: Will you explain how the MPPR applies to imaging?

Arizona Subscriber

Answer: 2012 dates of service, Medicare applies the Multiple Procedure Payment Reduction (MPPR) to both the professional and technical components of several specified diagnostic imaging procedures. You can see the list of affected codes in Attachment 1 of CR7442 at www.cms.gov/Transmittals/downloads/R995OTN.pdf. You'll find mostly MRI and CT codes with some ultrasound codes, as well.

The MPPR "applies when multiple services are furnished by the same physician to the same patient in the same session on the same day," states MLN Matters article MM7442 (http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7442.pdf).

Group practice note: If two physicians in the same group practice see the same patient on the same date, the MPPR doesn't apply. On the other hand, "If the same physician within a group practice sees the same patient in the same session on the same day, the imaging MPPR will apply," states MM7442.

The math: When you submit a claim with codes affected by the MPPR, Medicare will make full payment for the professional and technical components of the code with the highest payment rate under the fee schedule. Subsequent codes will be reimbursed at 75 percent for the professional component and 50 percent for the technical component.