Professional Component MPPR Will NOT Apply to Group Practices at This Time

As we reported in previous blog entries regarding the 2012 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (“CMS”) will be expanding its application of the Multiple Procedure Payment Reduction (“MPPR”) to the professional component (“PC”) of certain diagnostic imaging procedures. Currently, the MPPR only applies to the technical component (“TC”) of certain diagnostic imaging services where full payment is made for the service with the highest TC payment and payment is made at 50% for each subsequent service furnished by the same physician to the same patient in the same day. Under the new rule, full payment will be made for each PC and TC service with the highest payment with payment made at 75% for each subsequent PC service furnished by the same physician to the same patient on the same day. CMS will not be applying the imaging PC MPPR provided by group practices at this time.

For more information, please contact Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq. or Stephanie P. Ottenwess, Esq. at (248) 996-8510 or (212) 734-0128 or visit the HLP website.