Posted in Insurance, Training, Updates

MVP Plans (NY) Cardiovascular and Ophthalmology TC Reimbursement Policy 2021

Full Name of this policy is: Multiple Procedure Reduction on the Technical Component of Diagnostic Cardiovascular and Ophthalmology Procedures Payment Policy

Effective Date is February 03/2021

This policy will follow the reimbursement standards set forth by the CMS, under the MVP Multiple Procedure Payment Reduction (MPPR) policy. The MPPR policy regarding diagnostic cardiovascular and ophthalmology procedures apply when multiple services are furnished to the same patient on the same day. The MPPR policy applies independently to cardiovascular and ophthalmology services. The MPPR policy applies to TC-only services, and to the TC of global services.

For cardiovascular services: 100% reimbursement is made for the TC service with the highest payment. Reimbursement is made at 75% for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, i.e., same Group National Provider Identifier (NPI)) to the same patient on the same day.

For ophthalmology services: 100% reimbursement is made for the TC service with the highest payment. Reimbursement is made at 80% for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, i.e., same group NPI) to the same patient on the same day. The MPPR policy does not apply to the professional component.

The complete lists of codes subject to the MPPRs on diagnostic cardiovascular and ophthalmology procedures are in Attachments 1 and 2 of CR7848 respectively. CR7848 is available at http://www.cms.gov/Regulations[1]and-Guidance/Guidance/Transmittals/Downloads/R1149OTN.pdf

Source: MVP provider fax announcements.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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