tci General Surgery Coding Alert - 2009 Issue 12

Reader Questions: Let Payers Reduce Your Multiple Procedure Fees

Question: Are insurance companies allowed to reduce our fees for multiple procedures performed during the same session? If so, should I be reducing the fee before sending the claim? California Subscriber Answer: Many payers, including Medicare, follow a reduced fee policy for multiple procedures performed during the same operative session. Generally, the policy looks something like this: • Procedure 1 is paid at 100 percent of the allowable • Procedure 2 is paid at 50 percent of the allowable • Procedure 3 is paid at 25 percent of the allowable (for some payers) and 50 percent of the allowable...

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