Multiple Surgery Pricing Logic

Medicare pays for multiple surgeries by ranking from the highest physician fee schedule amount to the lowest physician fee schedule amount. When the same physician performs more than one surgical service at the same session, the allowed amount is based on 100% of the highest physician fee schedule amount. The allowed amount for the subsequent surgical codes is based on 50% of the physician fee schedule amount for each of the other codes. Medicare requires no modifier for multiple surgical procedures. Medicare prices bilateral procedures (Modifier 50) as one allowed amount when ranking the services. For endoscopic procedures, Medicare applies the endoscopic pricing rules prior to the multiple surgery rules. Multiple surgery pricing logic also applies to assistant at surgery.

Page Last Updated: Monday, 22-Aug-2011 11:11:05 CDT