AmeriHealth is updating its reimbursement position for outpatient facility providers for multiple procedure payment reductions (MPPR) for certain diagnostic services. This update does not affect outpatient facilities that are reimbursed using the ambulatory payment classifications methodology.
MPPR reimbursement methodology for outpatient facility providers
Effective September 1, 2021, MPPR guidelines apply to the following for facility providers:
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Group A
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Group B
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Group C
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|---|
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Procedures with highest allowance | 100% | 100% | 100% |
Each subsequent procedure | 85% | 94% | 75% |
Learn more
Find more information on how certain diagnostic services are reimbursed under the MPPR guidelines in the AmeriHealth Claim Payment Policy #00.01.60f: Multiple Procedure Payment Reduction on Certain Diagnostic Services, which was posted as a Notification on June 1, 2021, with an effective date of September 1, 2021.
Refer to Attachment A of this policy document to see the list of CPT® codes for multiple reduction diagnostic services to which the methodologies described above applies.
To view this policy Notification, visit our Medical and Claim Payment Policy Portal.
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