Multiple Procedure Payment Rule

Effective for dates of service on or after August 1, 2015, BCBSNC will apply a MPPR adjustment when certain diagnostic radiology procedures are supplied in combination by the same physician to the same patient during the same session on the same day. Consistent with the CMS national physician fee schedule (NPFS), BCBSNC will recognize the technical component (TC) of the primary procedure at 100 percent and will apply a 50 percent MPPR adjustment to the TC of the second and each subsequent procedure. This adjustment will apply to claims filed with the TC modifier (-TC) and to the TC portion of services that are billed globally. Additionally, BCBSNC will recognize the professional component (PC) of the primary procedure at 100 percent and will apply a 25 percent MPPR adjustment to the PC of the second and each subsequent procedure. This adjustment will apply to claims filed with the PC modifier (-26) and to the PC portion of services that are billed globally. MPPR adjustments will not apply when multiple imaging procedure codes are appended with modifier “-59” to indicate the procedure was performed on the same day but not during the same session.