Multiple Surgery Payment Reduction (MPPR)

Medicare and commercial payers typically apply multiple procedure payment reduction rules when reimbursing facilities and providers for multiple surgeries performed on the same date of service. This means that when more than one procedure is performed during the same session by the same provider, payers will reimburse the highest paying procedure at 100% and reduce payment for any second or subsequent procedure by 50%. The reason is that preoperative, intra-operative, and post-operative work often overlaps when more than one procedure is performed on the same day.

Tendo Marketplace has adopted this same logic, creating an automated smart shopping cart that applies the discount to the cart when multiple procedures are purchased together for the same episode of care.

How the Process Works

When two or more procedures that are priced more than $500 are purchased together and will be performed on the same day in the same encounter (session), the highest priced procedure will be priced at 100%, and the second procedure (or any subsequent procedures) will be priced at 50% for the facility fee, physician fee, and anesthesia fee.

Example

A 50% discount was applied to the facility fee, physician fee, and anesthesia fee on the second procedure because both procedures were purchased and performed together.

Specialities that are exempt from the discount:

• Pathology - Pathology will not receive a discount because when combining multiple procedures, specimen collection usually increases.
• Imaging and Nuclear Medicine - Imaging/Nuclear Medicine will not receive a discount as Tendo Marketplace’s imaging procedures have already been listed at a discounted price compared to the competitive market.
• Laboratory Services - Laboratory services will not receive a discount as these services are considered diagnostic tests, not procedures.
• Therapy Services - Therapy services will not receive a discount as they are purchased on a per session basis
• Emergency Room Services - Emergency Room services will not receive a discount as they are purchased based on a flat rate per level of visit.