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Earlier this year, as part of its 2019 Physician Fee Schedule Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) raised the possibility that it might reduce by 50 percent payments for same-day E/M services provided with procedures. Now, with the release of the 2019 Physician Fee Schedule Final Rule, CMS has reversed the […]
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The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical […]
AAPC Knowledge Center
Anthem has sent a letter to the AMA to announce they are rescinding the policy reducing payment for physicians when billing an E/M with a modifier 25 and a procedure that has zero or 10 global days. Anthem was planning on taking a 25 percent reduction on all 25 modified services billed with minor procedures as […]
AAPC Knowledge Center