UnitedHealthcare has announced plans to expand its current multiple procedure payment reduction (MPPR) policy for imaging services covered by its commercial health insurance plans to the professional component (PC) of imaging services beginning on November 15, 2015. Under the new policy, the professional reimbursement rates for high-tech imaging services performed by the same physician in the same session will be reimbursed at 100 percent for the first service and 75 percent for the second and subsequent services.
ADVOCATE is extremely concerned about this change. Clients are encouraged to carefully review their contracts to determine if there is a specific notification requirement for such policy changes. UnitedHealthcare claims that they are making the change in order to align with Medicare’s policy but acknowledged that CMS has not provided the data to substantiate their position. UnitedHealthcare executives expressed an interest in receiving updates on Congressional and CMS actions but indicated that they would move forward with their planned implementation on November 15th. They will, however, consider a policy change upon reversal of the Medicare policy by CMS or Congress. They also indicated that practices may use the -59 modifier to indicate separate sessions when appropriate.
The ACR has developed materials to assist in the fight against expansion of private payer MPPR policies. You can sign on to the ACR’s efforts by emailing Katie Keysor at firstname.lastname@example.org by November 6, 2015. Include your full name and indicate that you support the fight against UnitedHealthcare’s plans to expand its MPPR policy for imaging services beginning on Nov. 15, 2015.
As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.
Kirk Reinitz, CPA