CurrentHighmark Blue Cross Blue Shield WnyPolicy G-12002

Multiple Radiology Payment Reduction (MPPR)

Defines professional reimbursement and multiple procedure payment reduction (MPPR) for multiple diagnostic imaging procedures for applicable Highmark BCBS MMC, HARP, Child Health Plus, and Essential Plan members. Applies to professional providers and provider groups; does not apply to facility reimbursement unless otherwise noted.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyMultiple Radiology Payment Reduction (MPPR)

Policy CodePolicy G-12002

Change TypeMPPR applicability clarifiedmodifier exceptions clarifiedhistorical percentage update noted

Effective DateDec 10, 2024

Next Review Date

Key ActionFollow authorization and medical necessity guidelines and bill using proper CPT/HCPCS; apply MPPR when same provider/group performs multiple imaging procedures on the same date unless modifier 59 or X{EPSU} indicates different session.

SourceLink

POLICY UPDATE CHANGES

added (MPI) of 4 language.

MPPR percentages updated; professional and facility reimbursement language added.

provider group and X{EPSU} modifiers language added

100%highest valued imaging procedure

60%second & additional procedures

MPI=4MPI subject to MPPR

G-12002policy

2024-12-10effective

Multiple Radiology Payment Reduction (MPPR) Coverage Criteria

MPPR Coverage Criteria

Reimbursement stance for multiple diagnostic imaging procedures performed by the same provider or provider group on the same date of service and during the same patient encounter.

MPPR applies to diagnostic imaging procedures with CMS NPFS multiple procedure indicator (MPI) of 4 when performed by the same provider or provider group on the same date of service and during the same patient encounter.

ALL of the following

Highest valued procedure reimbursed at 100% of the fee schedule or contracted/negotiated rate.
Second and additional procedures reimbursed at 60% of the fee schedule or contracted/negotiated rate.

ALL of the following

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyMultiple Radiology Payment Reduction (MPPR)

Policy CodePolicy G-12002

Change TypeMPPR applicability clarifiedmodifier exceptions clarifiedhistorical percentage update noted

Effective DateDec 10, 2024

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Authorization, Billing, and Submission Guidance

Billing Rule

Authorization, Billing, and MPPR Billing Rules

Services must meet authorization and medical necessity guidelines and be billed with appropriate CPT, HCPCS, and/or revenue codes fully supported in the medical record; failure to follow coding/billing or reimbursement policies may result in claim rejection, denial, recovery/recoupment, or adjusted reimbursement. When the same provider or provider group performs multiple diagnostic imaging procedures with a CMS NPFS MPI of 4 on the same date of service and during the same patient encounter, MPPR applies: the highest valued procedure is reimbursed at 100% and the second and additional procedures are reimbursed at 60% of the fee schedule or contracted rate. The reduced allowance for second and subsequent procedures does not apply when multiple imaging procedures are reported with modifier 59 or X{EPSU} to indicate the procedures were done on the same day but not during the same session. A single imaging procedure submitted with multiple units is subject to multiple imaging reductions.

Obtain any required prior authorization and ensure medical necessity documentation is in the record (services must meet authorization and medical necessity guidelines).
Bill using industry-standard CPT, HCPCS, and/or revenue codes; ensure all billed codes are fully supported by the medical record.
Expect MPPR when same provider/group performs multiple imaging procedures with CMS NPFS MPI = 4 on the same date/encounter: highest valued procedure paid at 100%, additional procedures at 60%.
Do not apply the reduced allowance when modifier 59 or X{EPSU} is appended to indicate procedures were not performed during the same session.
Be aware that improper coding/billing may lead to claim rejection, denial, recoupment, or adjusted reimbursement.

Key Terms and Abbreviations

MPPR — Multiple Procedure Payment Reduction

DefinitionMultiple Procedure Payment Reduction (MPPR) — a reduction applied to reimbursement when multiple diagnostic imaging procedures subject to MPPR are performed by the same provider or provider group on the same date and encounter.

PurposeTo adjust payment so that the highest valued procedure is paid at full rate and subsequent procedures receive a reduced allowance.

ScopeApplies to professional reimbursement for diagnostic imaging procedures with CMS NPFS MPI of 4; does not apply to facility reimbursement unless otherwise noted.

Multiple Procedure Indicator (MPI)

MPI value in policyCMS NPFS Multiple Procedure Indicator (MPI) = 4 is identified in this policy as subject to MPPR.

Source referenceMPI referenced in the policy text as the NPFS indicator determining MPPR applicability.

Related coding noteStandard correct coding applies; a single imaging procedure submitted with multiple units may be subject to multiple imaging reductions.

OpenPayer

Multiple Radiology Payment Reduction (MPPR)

Multiple Radiology Payment Reduction (MPPR) Coverage Criteria

MPPR-Eligible Procedures and Reimbursement Rates

Authorization, Billing, and Submission Guidance

Key Terms and Abbreviations