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CMS-1403-FC
pricing of IVIG and Medicare beneficiary access to this
important therapy.
2. Multiple Procedure Payment Reduction for Diagnostic
Imaging
In general, we price diagnostic imaging procedures in
the following three ways:
● The PC represents the physician’s interpretation
(PC-only services are billed with the 26 modifier).
● The TC represents PE and includes clinical staff,
supplies, and equipment (TC-only services are billed with
the TC modifier).
● The global service represents both PC and TC.
Effective January 1, 2006, we implemented a multiple
procedure payment reduction (MPPR) on certain diagnostic
imaging procedures (71 FR 48982 through 49252 and
71 FR 69624 through 70251). When two or more procedures
within one of 11 imaging code families are furnished on the
same patient in a single session, the TC of the highest
priced procedure is paid at 100 percent and the TC of each
subsequent procedure is paid at 75 percent (a 25 percent
reduction). The reduction does not apply to the PC.
It is necessary to periodically update the list of
codes subject to the MPPR to reflect new and deleted codes.
In the CY 2009 PFS proposed rule, we proposed to subject
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