June 14, 2018

Question:
What is Medicare’s multiple procedure payment formula? When I do more than one procedure, I know Medicare reduces payment for some but I can’t remember by how much.

Answer:
It used to be 100%, 50%, 25%, 25%, etc but many years ago the formula changed to the physician’s advantage and now is 100%, 50% for subsequent stand-alone procedures.  Remember, add-on codes (+) and codes exempt from modifier 51 (⦸) are always paid at 100% of the allowable.

*This response is based on the best information available as of 06/14/18.