Revisions to the Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy — Professional Component Reduction Change

CMS announced in Transmittal 3578 dated Aug. 5, 2016 that effective for dates of service on or after Jan. 1, 2017, the Multiple Procedure Payment Reduction (MPPR) for the Professional Component (PC) of the second and subsequent procedures would change from 25 percent to 5 percent. This change applies to UnitedHealthcare Commercial and UnitedHealthcare Medicare Advantage plans. To align with CMS, UnitedHealthcare will revise the MPPR for Diagnostic Imaging Policy by applying a PC reduction to secondary and subsequent diagnostic imaging procedures of 5 percent effective for claims reported with a date of service on or after Jan. 1, 2017. To be consistent with CMS, the MPPR on the technical component (TC) of diagnostic imaging procedures remains at 50 percent.

Source: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/November-Final-2016-Network-Bulletin-PCA-1-003772_2016.pdf