​Now in effect: MPPR on certain diagnostic services for outpatient facility providers

September 3, 2021

Independence's updated 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:

  • Independence 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 Independence 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 Independence Administrators at this time. Once this has been corrected, it will be implemented for Independence Administrators and a notice will be published.

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