Multiple Procedure Payment Reduction

Date: December 19, 2012

On November 1, 2012, CMS released the revisions to the Medicare Physician Fee Schedule for 2013. A new payment policy called the Multiple Procedure Payment Reduction (MPPR) affects ophthalmologists and optometrists with a payment reduction when more than one diagnostic test is performed on the same day to the same patient.

This payment policy reduces the technical component of the second and subsequent diagnostic tests by 20% when more than one diagnostic test is performed at one patient encounter on the same day by the same physician or group. The list of tests includes ultrasounds, imaging and visual fields. Tests that do not have a technical component (e.g., gonioscopy) are not subject to this policy.

The diagnostic test with the higher-reimbursed technical component will be paid in the full. Subsequent tests will realize a 20% reduction to the technical component. For example, if you perform a visual field (92083) and a SCODI (92134) on the same day, the calculation is as follows. For the purposes of illustration, we utilized the 2012 reimbursement rates for both 2012 and 2013.

Sample Ophthalmology Payment Reduction

Code 92083

Code 92134

Total CY 2012 Payment

Total CY 2013 Payment

Payment Calculation

PC

$27.57

$28.59

$56.16

$56.16

no reduction

TC

$61.95

$16.34

$78.29

$75.02

$61.95

+ (0.8 x $16.34)

Global

$89.52

$44.93

$134.45

$131.18

$56.16 + $61.95

+ (0.8 x $16.34)

For additional information you can access the CMS MedLearn Matters file from 11/06/12 at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7848.pdf.

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