The updated AmeriHealth reimbursement position for outpatient facility providers is now in effect for multiple procedure payment reductions (MPPR) applied to certain diagnostic services.
This update does not affect:
- AmeriHealth Administrators*
- outpatient facilities that are reimbursed using the ambulatory payment classifications methodology
MPPR guidelines apply to the following for facility providers:
|
Group A |
Group B |
Group C |
|---|
Procedures with highest allowance
| 100% | 100% | 100% |
Each subsequent procedure | 85% | 94% | 75%
|
Visit our Medical and Claim Payment Policy Portal to review AmeriHealth Claim Payment Policy #00.01.60f: Multiple Procedure Payment Reduction on Certain Diagnostic Services.
Refer to Attachment A of this policy document to see the list of relevant CPT® codes for multiple reduction diagnostic services.
*Due to system limitations, this update cannot be made for AmeriHealth Administrators at this time. Once this has been corrected, it will be implemented for AmeriHealth Administrators and a notice will be published.
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