CMS Expands MPPR Policy to Apply to the Professional Component of Certain Diagnostic Imaging Services

Effective January 1, 2012, The Centers for Medicare and Medicaid Services (CMS) expanded its Multiple Procedure Payment Reduction (MPPR) policy to the professional component of certain diagnostic imaging services.  Prior to this year, the MPPR only applied to the technical component of certain imaging services, but now CMS is applying the policy to the professional component as well.

The MPPR applies when multiple diagnostic imaging services are provided by the same physician to the same patient in the same session on the same day.  Full payment is issued on the service performed with the highest payment per the Medicare Physician Fee Schedule.  Payment is made at 75% for the professional component of any subsequent CPT codes (50% for the technical component) that are subject to the MPPR.

It is important to note that, due to operational limitations, CMS is not applying the MPPR to group practices at this time when different physicians within the group provide services to the same patient in the same session on the same day.  However, if the same physician within a group practice provides services to the same patient in the same session on the same day, the MPPR will apply.

A complete list of the CPT codes that are subject to the diagnostic imaging MPPR can be found at: 

http://www.cms.gov/Transmittals/downloads/R995OTN.pdf

Currently, Medicare is the only payor that is applying the MPPR policy to the professional component of imaging services.  No private payors are currently applying the MPPR policy to these services.

Through the first five months of 2012, APS has seen a decrease in Medicare payments of 1.5-2.5% for our multi-physician radiology clients solely as an effect of the expanded MPPR policy.