Reimbursement Policy Update: Multiple Procedure Payment Reduction for Endoscopies

Effective January 20, 2021, we will align our approach to the processing of certain claims for endoscopy services with that of the Centers for Medicare & Medicaid Services (CMS) Multiple Procedure Payment Reduction (MPPR) guidelines.

This change will help ensure that the processing of claims for services provided to our members is in line with current standard business practices in regard to coding and billing rules and guidelines, including CMS National Correct Coding Initiative (NCCI).

We encourage you to review the Pay Percent Multiple Endoscopy Rule section within our ClaimsXten Editing Rules reimbursement policy which outlines the guidelines we will follow in the processing of claims for multiple eligible endoscopic procedures submitted for the same provider or same group practice and same date of service.

These guidelines will be applied to professional claims for services provided January 20, 2021 and after to patients enrolled in insured commercial plans and those Administrative Services Only (ASO) group plans that have opted-in to these policy guidelines. Claims for services rendered prior to January 20, 2021 will not be impacted.

This update, originally announced for implementation in early 2020, was delayed in a notice posted in June 2020.