CurrentBlue Cross Blue Shield - WisconsinPolicy G-12002

Multiple Radiology Payment Reduction (MPPR)

Defines Anthem Blue Cross and Blue Shield reimbursement reductions when multiple diagnostic imaging procedures (with CMS MPI=4) are performed by the same provider or provider group on the same date of service during the same member encounter; applies to professional and facility claims unless overridden by provider, state, federal, or CMS contracts or requirements.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyMultiple Radiology Payment Reduction (MPPR)

Policy CodePolicy G-12002

Change TypeMaterial wording update (MPI=4 addedCT guidance removed)

Effective DateApr 1, 2026

Next Review Date

Key ActionApply MPPR when multiple diagnostic imaging procedures with CMS NPFS MPI=4 are performed by the same provider or provider group on the same date of service during the same encounter; use modifier 59 or X{EPSU} to avoid MPPR when appropriate.

SourceLink

POLICY UPDATE CHANGES

Added language of MPI 4 to policy body.

Removed language stating CT scan services are not subject to a multiple procedure payment reduction.

95%professional component reimbursement for second and subsequent procedures

50%technical component reimbursement for second and subsequent procedures

MPI = 4CMS NPFS multiple procedure indicator referenced

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Multiple Procedure Payment Reduction Coverage Criteria

MPPR coverage criteria

Reimbursement rules for multiple diagnostic imaging procedures within the same encounter:

MPPR applies to multiple diagnostic imaging procedures with CMS NPFS MPI = 4 when performed by the same provider or provider group on the same date of service during the same member encounter.

The global procedure, professional component, or technical component will reimburse at 100% of the contracted/negotiated rate for the procedure with the highest allowance; subsequent procedures will reimburse at reduced percentages.

ALL of the following

Professional component reimbursement for second and subsequent procedures: 95% of the professional component.
Technical component reimbursement for second and subsequent procedures: 50% of the technical component.

Modifier exception: A reduced allowance for second and subsequent procedures will not apply when multiple imaging procedures are reported with modifier 59 or modifier X{EPSU} to indicate the procedure was done on the same day but not during the same session.

A single imaging procedure submitted with multiple units remains subject to multiple imaging reductions.

Policy may be superseded by provider, state, federal, or CMS contracts and/or requirements; services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

Coding and Modifier Guidance

Relevant modifiers and coding guidanceModifier

Modifier 59	Distinct procedural service; may prevent MPPR when valid
Modifiers XE, XP, XS, XU	Clarify distinct procedural services per CMS guidance
Modifier 26	Professional component
Modifier TC	Technical component

MPI indicator threshold

MPI indicator thresholdApplies when CMS National Physician Fee Schedule (NPFS) multiple procedure indicator (MPI) = 4.

MPPR triggerMPPR applies when multiple diagnostic imaging procedures with NPFS MPI=4 are performed by the same provider or provider group on the same date of service during the same member encounter.

ScopeApplies to professional and facility reimbursement unless overridden by provider, state, federal, or CMS contracts/requirements.

Provider Billing and Claim Submission Guidance

Billing Rule

Apply MPPR for MPI = 4; use modifier 59 or X{EPSU} to avoid reduction

When multiple diagnostic imaging procedures with the CMS NPFS multiple procedure indicator (MPI) of 4 are performed by the same provider or provider group on the same date of service during the same member encounter, a multiple procedure payment reduction (MPPR) will be applied; use modifier 59 or the appropriate X{EPSU} modifier to indicate procedures performed the same day but not during the same session to avoid MPPR. Services must still meet authorization and medical necessity requirements and be billed with industry‑standard, compliant codes.

MPPR applies when CMS NPFS MPI = 4 and procedures are by the same provider/group on the same date during the same encounter.
Report modifier 59 or X{EPSU} to indicate the procedure was done the same day but not during the same session to prevent the reduced allowance.
Ensure services meet authorization and medical necessity guidelines and are billed with CPT/HCPCS/revenue codes supported in the medical record.

Definitions

Definitions referenceSee 'General Reimbursement Policy Definitions' for full list of terms and definitions used in this policy.

Policy contextDefinitions support interpretation of reimbursement rules for multiple diagnostic imaging procedures and related MPPR application.

Related materialsRelated policy documents (Modifier Usage; Modifiers 26 and TC; Modifiers 59, XE, XP, XS, XU) provide additional definition and coding guidance.