Section 20-2-II - MULTIPLE PROCEDURESA.Multiple Procedure Reimbursement Rule.Multiple procedures performed during the same operative session at the same operative site are reimbursed as follows:
* One hundred percent (100%) of the MAR for the primary procedure
* Fifty percent (50%) of the MAR for the second and subsequent procedures
B.Bilateral Procedure Reimbursement Rule. Bilateral procedures are identical procedures (i.e., use the same CPT code) performed on the same anatomic site but on opposite sides of the body. Furthermore, each procedure should be performed through its own separate incision to qualify as bilateral. For example, open reductions of bilateral fractures of the mandible treated through a common incision would not qualify under the definition of bilateral and would be reimbursed according to the multiple procedure rule. Medicare's accepted method of billing bilateral services is to list the procedure once and add modifier 50. Mississippi is adopting this same policy. Refer to the example below: 69300 50 Otoplasty, protruding ear, with or without size reduction
Place a "2" in the UNITS column of the CMS-1500 claim form so that payers are aware that two procedures were performed. List the charge as one hundred fifty percent (150%) of your normal charge. Reimbursement shall be at one hundred fifty percent (150%) of the amount allowed for a unilateral procedure(s). For example, if the allowable for a unilateral surgery is one hundred dollars ($100.00) and it is performed bilaterally, reimbursement shall be one hundred fifty dollars ($150.00). However, if the procedure description states "bilateral," reimbursement shall be as listed in the Fee Schedule since the fee was calculated for provision of the procedure bilaterally.
C.Multiple Procedures-Different Areas Rule. When multiple surgical procedures are performed in different areas of the body during the same operative sessions and the procedures are unrelated (e.g., abdominal hernia repair and a knee arthroscopy), the multiple procedure reimbursement rule will apply independently to each area. Modifier 51 must be added.D.Multiple Procedure Billing Rules1. The primary procedure, which is defined as the procedure with the highest RVU, must be billed with the applicable CPT code.2. The second or lesser or additional procedure(s) must be billed by adding modifier 51 to the codes, unless the procedure(s) is exempt from modifier 51 or qualifies as an add-on code.