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Clinical Editing Reminder: Multiple Procedure Payment Reduction Rules

Audience: Participating Providers

Excellus BlueCross BlueShield follows the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction rules for all lines of business. When multiple surgeries or procedures are performed by a single physician, or when physicians in the same group practice perform surgery on the same patient, reduction in reimbursement for secondary and subsequent procedures may occur.

Excellus BCBS uses the Medicare Physician Fee Schedule to apply the multiple payment methodology, per CMS guidelines. CMS updates its physician fee schedule several times throughout the year. We encourage providers not to reduce the charge amount on any subsequent procedures billed. Excellus BCBS will apply the multiple procedure payment reduction rules for the provider based on the current Medicare Physician Fee Schedule, eliminating the need for the provider to review each code when billing.

Most medical and surgical procedures include pre-procedure, intra-procedure, and post-procedure work. When multiple procedures are performed at the same patient encounter, there is often overlap of the pre-procedure and post-procedure work. Payment methodologies for procedures account for the overlap of the pre-procedure and post-procedure work.

View the Medicare Physician Fee Schedule

Thank you for the quality of care and service that you provide to our valued members. 

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Excellus

Clinical Editing

Updates and Reminders

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