CMS Multiple Procedure Reduction

The CMS Multiple Procedure Reduction tool lets you reduce the reimbursement of a procedure code according to the multiple procedure logic of Medicare.

This reimbursement tool adjusts the reimbursement for codes that have already been reimbursed through other nodes. This means that only codes that have their resources consumed are eligible for multiple procedure reduction through this tool.

Select the Multiple Endoscopy Family Rules option:

Click Apply multiple endoscopy family rules to apply the Multi-Surg Reduction to procedures with a Multi-Surg indicator of 1 or 2 only, and apply the multiple endoscopy family rules to procedures with a Multi-Surg indicator of 3.
Clear Apply multiple endoscopy family rules to apply the Multi-Surg Reduction to all procedures with a Multi-Surg indicator of 1, 2, or 3.

Select the Use % of Base RVU for Secondary Endoscopy Reduction option:

Click Use % of Base RVU for Secondary Endoscopy Reduction to apply this option so that code with the highest Total RVU prices at 100% and the second highest code prices using the Adjusted RVU.
Clearing the Use % of Base RVU for Secondary Endoscopy Reduction indicates that the option is not used by this reimbursement.

Select Apply Adjusted Total Family RVU for Multiple Procedure Reduction option

Click Apply Adjusted Total Family RVU for Multiple Procedure Reduction to apply this option so that the Adjusted Total Family RVU is calculated and compared to the unrelated code to determine the appropriate endoscopy reduction.
Clearing Apply Adjusted Total Family RVU for Multiple Procedure Reductionindicates that the option is not used by this reimbursement.

Select the Consider All Codes option to observe or bypass the CMS limits against pricing more than seven surgical procedure codes for the same date of service.

Click Consider All Codes to bypass the CMS limits and price all of the surgical procedure codes with the same DOS.
Clear Consider All Codes to observe the CMS limits and price up to seven surgical procedure codes with the same DOS.

Select the Override Multiple Surgery Discount to override the multipliers to differ from Medicare.

Multiple Multipliers can be entered to override the multipliers to differ from Medicare.
Click Limit Codes Reimbursed to number of Multipliers to apply this option.

Field Descriptions

The following table describes the fields on the CMS Multiple Procedure Reduction reimbursement tool.

Field	Description
Override Medicare Table Effective Date	Date field allowing the override of the reference RVU effective date.
Apply multiple endoscopy family rules	Applies the multiple endoscopy family rules to all procedures with a Multi-Surg indicator of 3.
Use % of Base RVU for Secondary Endoscopy Reduction	Applies the percent of Base RVU for Secondary Endoscopy Reduction. The code with the highest Total RVU prices at 100% and the second highest code prices using the Adjusted RVU.
Apply Adjusted Total Family RVU for Multiple Procedure Reduction	When the option Apply Adjusted Total family RVU for Multiple Procedure Reduction is selected and there are multiple codes in one family with an unrelated code, the system considers the following: Is the applicable endoscopy reduction for the two codes in the same family? Next, the adjusted RVU amount for the second code in that family (Codes RVU - Base Code RVU) is added to the first code in that family's RVU. This becomes the Adjusted Total family RVU. (If this radio button is not selected, the code just adds the total RVU of the two codes.) The Adjusted Total family RVU and the RVU for the unrelated procedure are compared. If the Adjusted total family RVU is higher, both codes in that family get 100% of their endoscopy calculation and the Unrelated receives 50%. If the Adjusted total family RVU is lower, the Unrelated gets 100% and the two family codes receive 50% of their endoscopy calculations.
Consider All Codes	Determines if the CMS Multiple Procedure Reduction limit is observed or bypassed. Click Consider All Codes to bypass the CMS limits and price all of the surgical procedure codes with the same DOS. Clear Consider All Codes to observe the CMS limits and price up to seven surgical procedure codes with the same DOS. Note: This is the default setting.
Override Multiple Surgery Discount	Select this option to override the multipliers to differ from Medicare.
Multipliers	Multiple multipliers can be entered for the Medicare Override Multiple Surgery Discount. Note: This option is only available when the Override Multiple Surgery Discount check box is selected. Show me Click image to play video and click video to close.
Limit Codes Reimbursed to number of Multipliers	Select this option to limit codes reimbursed to number of multipliers. Note: This option is only available when the Override Multiple Surgery Discount check box is selected.
Override the RVU for the following codes	Select this option to load a Procedure Look-up table with the CPTs and the RVU value as the base rate. Note: If the code does not exist in the override table, the Medicare RVU values are used.