Medicare Advantage Preferred Provider Organization (MA PPO)

Applicable to enrollees from other Blue Cross Blue Shield Medicare Advantage Plans who obtain health care services within the 5-county Philadelphia service area.

Notification

Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services

Notification Issued Date: N/A

This version of the policy becomes effective 12/16/2019. The policy update clarifies the Company's Multiple Procedure Payment Reduction (MPPR) guidelines for reimbursement for eligible multiple diagnostic reduction services. The clarification states the following:

The MPPR guidelines apply to services identified in Groups A and B of Attachment A that are billed during the same session on the same claim form.
The MPPR guidelines apply to services identified in Group C of Attachment A that are billed on the same claim form.
When multiple diagnostic services are performed in different sessions, modifier XE must be reported for the subsequent session(s).

Policy Attachment

Attachment to Policy #

MA01.005g

Attachment:

Policy #:

MA01.005g

Description:

Multiple Reduction Diagnostic Services

Title:

Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services

CPT CODES FOR MULTIPLE REDUCTION DIAGNOSTIC SERVICES:

GROUP A
CODE
0683T
0684T
0685T
75600
75605
75625
75630
75705
75710
75716
75726
75731
75733
75736
75741
75743
75746
75756
75809
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
75880
75885
75887
75889
75891
75893
78428
78445
78451
78452
78453
78454
78456
78457
78458
78466
78468
78469
78472
78473
78481
78483
78494
93000
93005
93015
93017
93024
93025
93040
93041
93050
93224
93225
93226
93229
93241
93242
93243
93245
93246
93247
93260
93261
93268
93270
93271
93278
93279
93280
93281
93282
93283
93284
93285
93286
93287
93288
93289
93290
93291
93292
93303
93304
93306
93307
93308
93312
93314
93318
93350
93351
93701
93702
93724
93784
93786
93788
93880
93882
93886
93888
93890
93892
93893
93895
93922
93923
93924
93925
93926
93930
93931
93970
93971
93975
93976
93978
93979
93980
93981
93985
93986
93990

GROUP B
CODE
0506T
0507T
0509T
76510
76511
76512
76513
76514
76516
76519
92025
92060
92081
92082
92083
92132
92133
92134
92136
92145
92228
92229
92235
92240
92242
92250
92265
92270
99273
92274
92283
92284
92285
92286

GROUP C
CODE
0648T
0689T
0697T
70336
70450
70460
70470
70480
70481
70482
70486
70487
70488
70490
70491
70492
70496
70498
70540
70542
70543
70544
70545
70546
70547
70548
70549
70551
70552
70553
70554
71250
71260
71270
71271
71275
71550
71551
71552
71555
72125
72126
72127
72128
72129
72130
72131
72132
72133
72141
72142
72146
72147
72148
72149
72156
72157
72158
72159
72191
72192
72193
72194
72195
72196
72197
72198
73200
73201
73202
73206
73218
73219
73220
73221
73222
73223
73225
73700
73701
73702
73706
73718
73719
73720
73721
73722
73723
73725
74150
74160
74170
74174
74175
74176
74177
74178
74181
74182
74183
74185
74261
74262
74712
75557
75559
75561
75563
75571
75572
75573
75574
75635
76391
76604
76700
76705
76770
76775
76776
76831
76856
76857
76870
76978
76981
76982
77046
77047
77048
77049

Version Effective Date:

01/01/2022

Version Issued Date:

02/08/2022

Version Reissued Date:

N/A