§ 9789.15.5. Ophthalmology Multiple Procedure Reduction.

(a) The Multiple Procedure Payment Reduction (MPPR) on ophthalmology procedures applies when multiple services are furnished to the same patient on the same day. The MPPRs apply to Technical Component (TC)-only services, and to the TC of global services. Full payment is made for the TC service with the highest payment. Payment is made at 80 percent for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, i.e., same Group National Provider Identifier (NPI)) to the same patient on the same day. The MPPR does not apply to professional component (PC) services. See section 9789.19 for the location of the list of codes subject to the MPPR on ophthalmology procedures, by date of service.

(b) For services subject to both the multiple procedure payment reduction and the OPPS cap on imaging, the MPPR shall be applied first, then the reduced amount will be compared with the OPPS cap, and the lower amount shall be used.

HISTORY

1. New section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 39).

Note

Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.