Facility Reimbursement for Multiple Procedures

Facility Reimbursement for Multiple Procedures

More than one surgical procedure may be performed in the same operative session. Special rules apply to this situation. When two or more procedures are performed that are subject to the multiple procedure discount, the ASC will be reimbursed at the full rate for the procedure classified with the highest payment. Any other procedures performed during the same session are reimbursed at 50% of the procedure’s applicable payment.

A procedure performed bilaterally in one operative session is reported as two procedures. Report the CPT code as 2 line items, not 1 line item with 2 units. Payment for eligible bilateral procedures will be reimbursed at 150% of the applicable rate. Procedures eligible for the bilateral payment adjustment are determined by CMS.

The multiple procedure payment reduction is the last pricing routine applied to applicable ASC procedure codes. In determining the ranking of procedures for application of the multiple procedure reduction, NHIC shall use the lower of the billed charge or the ASC payment amount. The ASC surgical services billed with modifier -52 and -73 shall not be subjected to further pricing reductions. (i.e., the multiple procedure price reduction rules will not apply). Payment for an ASC surgical procedure billed with modifier -74 may be subject to the multiple procedure discount if that surgical procedure is subject to the multiple procedure discount.