Wiki Medicare Adding modifier 51 to Holter

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Rosanat1991

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Medicare (Palmetto) added Modifier 51 to my holter monitors for January and reduced my payment by $27.25.
When I called Palmetto to find out WHY I was told it is part of the new MPPR Multiple Procedure Payment Reduction and to look up CR 7747.
When I explained that a holter monitor is not an imaging service I was told the MPPR rule still applies because the code has a professional component and a technical component.
Is anyone else having trouble with this?
I will appeal this decision, but would love to understand the logic before I do.
 
I don't think appealing will even help. This is a new measure starting Jan 2013 where CMS is reducing some reimbursement, or rather, the physician will have to reduce what they bill Medicare for professional and technical components of certain diagnostic imaging. Now, it also affects physicians in the same office under the same TxID.

You may find this article helpful: http://www.jdsupra.com/legalnews/cms-to-apply-the-multiple-procedure-paym-35018/.

http://www.ngsmedicare.com/wps/wcm/...ERES&CACHEID=b89cb5004d820b1e8dccbf2f4d16bb22

HTH
 
Our Medicare is doing that with us as well. The 93224 is broken down in to 2 technical components (93225, 93226) and 1 professional component (93227). When we bill the 93224, because both the 93225 and 93226 are on the list, they pay the 93226 at 100%, the 93225 at 75% and the 93227 at 100%. We are taking a $6.59 hit on each Holter that we do. One of our Docs wants to take it to the ACC and I'm currently working on giving him all of the details. Not sure that it will help, but it's worth a try if that's what he wants to do.
 
93224 - still not making sense

It still doesn't make sense to me because the reduced payment is happening when we only bill the one code of 93224. There is no other radiology code billed by us the same as the 93224.
 
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