Policy Updates Reimbursement PoliciesCommercialJune 30, 2023

New reimbursement policy Multiple Procedure Payment Reduction — Professional

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective April 12, 2023, Empire BlueCross BlueShield combined the Multiple Diagnostic Ophthalmology Procedures — Professional and Multiple Diagnostic Cardiovascular Procedures — Professional reimbursement policies into a single reimbursement policy titled Multiple Procedure Payment Reduction — Professional. This policy allows reimbursement based on the CMS national physician fee schedule’s (NPFS) multiple procedure indicator (MPI) payment-adjustment rules. When multiple services are performed on the same date of service, during the same encounter (and are performed by the same provider or provider group), the following procedures will be subject to multiple procedure payment reductions (MPPR):

  • Cardiovascular procedures
  • Ophthalmology procedures

The Multiple Diagnostic Ophthalmology Procedures - Professional and Multiple Diagnostic Cardiovascular Procedures - Professional reimbursement policies will be retired.

For specific policy details, visit: reimbursement policy page

NYBCBS-CM-027269-23-CPN27177

PUBLICATIONS: July 2023 Provider Newsletter