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August 7, 2018

Billing Multiple Procedures Performed on the Same Date of Service

Multiple surgeries are separate procedures performed by a single physician or physicians in the same group practice on the same patient at the same operative session or on the same day for which separate payment may be allowed.

Medicare pays for multiple surgeries by ranking from the highest Medicare Physician Fee Schedule (MPFS) amount to the lowest MPFS amount. When the same physician performs more than one surgical service at the same session:

  • The allowed amount is 100 percent for the surgical code with the highest MPFS amount.
  • The allowed amount for the subsequent surgical codes is based on 50 percent of the MPFS amount.

To ensure multiple surgery pricing occurs we ask that you submit multiple surgical procedures performed on the same day by the same physician/practitioner on the SAME claim.  Doing this may also reduce the number of overpayment requests sent asking for monies paid in excess of the multiple procedure payment rules. 

Additional information is available in the CMS Medicare Claims Processing Manual 100-04, Chapter 12, Section 40.6External PDF.

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