CPT 93000 Unbundling per MPPR
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We received this from UHC after we asked them why they were unbundling EKG
code 93000:
*Cpt 93000 is subject to MPPR (Multiple Procedure Payment Reduction). Per
CMS guidelines this became effective with claims reported on and after
11/15/2015 that are processed 12/12/2015 and after, UnitedHealthcare will
apply MPPR to applicable diagnostic imaging services(for Imaging,
Ophthalmology and Cardiology) Cpt 93000 is an eligible code for MPPR and
was billed globally. When processed this line will deny and crosswalk to
the professional and technical components of the new crosswalk codes. In
this case 93000 crosswalks to 93005 for the TC and to 93010 for the PC.
Please refer to the Multiple Procedure Payment Reduction for Diagnostic *
Does this sound right?
Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
Chief Operating Officer
North Scottsdale Family Medicine
LinkedIn: www.linkedin.com/in/charleneburgett
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We received this from UHC after=
we asked them why they were unbundling EKG code 93000:
Cpt 93000 is subject to=
MPPR (Multiple Procedure Payment Reduction). Per CMS guidelines this becam=
e effective with claims reported on and after 11/15/2015 that are processed=
12/12/2015 and after, UnitedHealthcare will apply MPPR to applicable diagn=
ostic imaging services(for Imaging, Ophthalmology and Cardiology) Cpt 93000=
is an eligible code for MPPR and was billed globally. When processed this =
line will deny and crosswalk to the professional and technical components o=
f the new crosswalk codes.=C2=A0 In this case 93000 crosswalks to 93005 for=
the TC and to 93010 for the PC.=C2=A0 Please refer to the Multiple Procedu=
re Payment Reduction for Diagnostic=C2=A0
Does this sound right?
Charlene Endre-Burgett=
, MS-HCM, =C2=A0CMA (AAMA), =C2=A0CPC, =C2=A0CMCS, CHM, CPOM
Chief Opera=
ting OfficerNor=
th Scottsdale Family Medicine
LinkedIn:=C2=A0 www.linkedin.com/in/charlene=
burgett
--94eb2c037d84e29cae0537504937--
Content-Type: text/plain; charset=UTF-8
We received this from UHC after we asked them why they were unbundling EKG
code 93000:
*Cpt 93000 is subject to MPPR (Multiple Procedure Payment Reduction). Per
CMS guidelines this became effective with claims reported on and after
11/15/2015 that are processed 12/12/2015 and after, UnitedHealthcare will
apply MPPR to applicable diagnostic imaging services(for Imaging,
Ophthalmology and Cardiology) Cpt 93000 is an eligible code for MPPR and
was billed globally. When processed this line will deny and crosswalk to
the professional and technical components of the new crosswalk codes. In
this case 93000 crosswalks to 93005 for the TC and to 93010 for the PC.
Please refer to the Multiple Procedure Payment Reduction for Diagnostic *
Does this sound right?
Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
Chief Operating Officer
North Scottsdale Family Medicine
LinkedIn: www.linkedin.com/in/charleneburgett
--94eb2c037d84e29cae0537504937
Content-Type: text/html; charset=UTF-8
Content-Transfer-Encoding: quoted-printable
We received this from UHC after=
we asked them why they were unbundling EKG code 93000:
Cpt 93000 is subject to=
MPPR (Multiple Procedure Payment Reduction). Per CMS guidelines this becam=
e effective with claims reported on and after 11/15/2015 that are processed=
12/12/2015 and after, UnitedHealthcare will apply MPPR to applicable diagn=
ostic imaging services(for Imaging, Ophthalmology and Cardiology) Cpt 93000=
is an eligible code for MPPR and was billed globally. When processed this =
line will deny and crosswalk to the professional and technical components o=
f the new crosswalk codes.=C2=A0 In this case 93000 crosswalks to 93005 for=
the TC and to 93010 for the PC.=C2=A0 Please refer to the Multiple Procedu=
re Payment Reduction for Diagnostic=C2=A0
Does this sound right?
Charlene Endre-Burgett=
, MS-HCM, =C2=A0CMA (AAMA), =C2=A0CPC, =C2=A0CMCS, CHM, CPOM
Chief Opera=
ting OfficerNor=
th Scottsdale Family Medicine
LinkedIn:=C2=A0 www.linkedin.com/in/charlene=
burgett
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Comments
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I did end up finding the UHC policy on this:
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesHtml/ReimbursementPolicies/MPPR Cardiovascular and Ophthalmology Procedures_2016A.pdf
Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
Chief Operating Officer
North Scottsdale Family Medicine
LinkedIn: www.linkedin.com/in/charleneburgett
Dawn Breithaupt
Preventive Medicine Associates