​​Now in effect: MPPR on certain diagnostic services for outpatient facility providers

September 3, 2021

The updated AmeriHealth reimbursement position for outpatient facility providers is now in effect for multiple procedure payment reductions (MPPR) applied to certain diagnostic services.

This update does not affect:

  • AmeriHealth Administrators*
  • outpatient facilities that are reimbursed using the ambulatory payment classifications methodology​

MPPR guidelines apply to the following for facility providers:

Group A Group B Group C

Procedures with highest allowance

100%

100%

100%

Each subsequent procedure

85%

94%

75%

Visit our Medical and Claim Payment Policy Portal to review AmeriHealth Claim Payment Policy #00.01.60f: Multiple Procedure Payment Reduction on Certain Diagnostic Services.

Refer to Attachment A of this policy document to see the list of relevant CPT® codes for multiple reduction diagnostic services.

*Due to system limitations, this update cannot be made for AmeriHealth Administrators at this time. Once this has been corrected, it will be implemented for AmeriHealth Administrators and a notice will be published.

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