This version of the policy will become effective 03/30/2020.
This policy has been updated to communicate the Company's continuing position on multiple surgery payment reduction (MSPR).
Applicable codes have been added and removed from the policy to reflect codes that are subject to MSPR.
Multiple surgery payment reduction (MSPR) represents the Company's methodology to determine the professional provider's reimbursement when multiple surgical procedures are performed by the same professional provider or professional providers in the same provider group, on the same individual, during the same operative session, or on the same date of service.
MSPR is not applied to Current Procedural Terminology (CPT) procedure codes that are classified by the American Medical Association (AMA) as add-on codes or Modifier 51 exempt codes and Healthcare Common Procedure Coding System (HCPCS) codes classified by the Company as add-on codes.
Refer to Attachments A1 and A2 (CPT) and B (HCPCS) for procedure codes that are subject to MSPR.
The hierarchy for reimbursement of multiple surgical procedures is determined based on the professional provider's allowance for each surgical procedure, as set forth below:
The following codes has been deleted from this policy:
0249T, 0254T, 0375T, 0377T, 19260, 19271, 19272, 19304, 20926, 33010, 33011, 33015, 33860, 33870, 35721, 35741, 35761, 43401, 64402, 64410, 64413
The following code narratives have been revised in this policy:
31233, 31235, 31292, 31293, 31294, 31295, 31296, 31297, 35701, 46945, 46946, 54640, 62270, 62272, 64400, 64405, 64408, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 66711, 66982, 66984
10035,31652,31653,33477,39401,39402,43210,47531,47532,47533,47534,47535,47536, 47537,47538,47539,47540,47541,49185,50430,50431,50432,50433,50434,50435,50693, 50694,50695,54437,54438,61645,61650,64461,64463,65785,69209,0402T,0404T,0406T, 0407T,0408T,0409T,0410T,0411T,0412T,0413T,0414T,0415T,0416T,0417T,0418T,0419T, 0420T, 0421T,0424T,0425T,0426T,0427T,0428T,0429T,0430T,0431T,0432T,0433T
The following CPT codes have been deleted to this policy: