September 20, 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 (Graphics – insert the symbol – circle with slash) are always paid at 100% of the allowable.
*This response is based on the best information available as of 09/20/18.
