Multiple Procedure Payment Reduction (MPPR) guidelines represent claims processing methodologies and guidelines for the reimbursement of certain diagnostic services when more than one are performed.

Effective January 1, 2015, MPPR guidelines will apply to certain diagnostic services performed by the same professional provider, on the same individual, and on the same date of service, regardless of setting. The guidelines may apply to some services performed during the same session or by professional providers within the same provider group.

Diagnostic services with the highest provider allowance will remain eligible for reimbursement at 100 percent. Depending on the grouping of the services, subsequent services may be eligible for reimbursement at 50, 75, or 80 percent.

For additional information, please refer to the Notifications for the Claim Payment Policy for Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services (#00.01.60 for commercial products and #MA01.005 for Medicare Advantage products), which are available on our Medical Policy Portal. Once you select Accept and Go to Medical Policy Online, select the appropriate policy portfolio. Then type the policy name or number in the Search box.