Two surgical procedures are performed for the same patient on the same day and multiple procedure payment reduction (MPPR) applies. What financial impact is expected for the secondary procedure under typical Medicare physician MPPR rules?
Select an answer to reveal the explanation.
Short Explanation
When two surgeries share the day, Medicare often pays the second one at a discount—not because the work vanished, but because overlapping practice costs are assumed. Expect a reduced percentage on the secondary line under MPPR, not a free full fee or an automatic noncover denial.
Full Explanation
Multiple procedure payment reduction policies typically pay the highest-valued procedure at the full fee-schedule amount and reduce payment for subsequent procedures performed at the same session, reflecting overlapping practice expense. Coders should anticipate reduced secondary-procedure payment under applicable MPPR rules rather than assuming full payment for each line, automatic noncoverage, or an RVU increase. Accurate coding and ranking still matter because reductions apply to correctly payable lines.