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Are eligible bilateral MRIs reduced by CMS according to MPPR rules?

Chris Posted Wed 09th of May, 2012 01:06:41 AM

For bilateral radiolog (example is MRI of the lower extremity, left and right), does CMS apply the MPPR policy? The bilateral surgery indicator is 3, but, the code is in the "88" family and MPPR applies. What is CMS doing with these claims?

SuperCoder Answered Wed 09th of May, 2012 07:49:07 AM

Yes, Effective Jan 1, 2012 MPPR is applicable for MRI, Lower extremity for both PC and TC component.
For PC component - 100% for first procedure and 75% for the subsequent procedures
For TC component - 100% for first procedure and 50% for the subsequent procedures
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As per CMS:
"The MPPR on diagnostic imaging applies when multiple services are furnished by the same physician to the same patient in the same session on the same day. Currently, the MPPR on diagnostic imaging services applies only the TC services. It applies to both TC-only services and to the TC portion of global services. Full payment is made for the service with the highest TC payment. Payment is made at 50 percent for the TC of subsequent services furnished by the same physician to the same patient in the same session on the same day."
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"CMS is expanding the MPPR by applying it to PC services. Full payment is made for each PC and TC service with the highest payment under the Medicare Physician Fee Schedule (MPFS). Payment is made at 75 percent for subsequent PC services furnished by the same physician to the same patient in the same session on the same day. Payment is made at 50 percent for subsequent TC services furnished by the same physician to the same patient in the same session on the same day. Due to operational considerations, at this time, CMS is not applying the imaging MPPR to group practices when different physicians in a group see the same patient on the same day. However, 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 as of January 1, 2012."
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For more insight, please check the following link:
http://www.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/NovDec2011/MPPR-Policy-To-Be-Applies-to-PC-in-2012.aspx
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http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads//MM7442.pdf
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https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads//R995OTN.pdf

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