California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 4.5 - Division of Workers' Compensation
Subchapter 1 - Administrative Director-Administrative Rules
Article 5.3 - Official Medical Fee Schedule
Section 9789.17.1 - Radiology Diagnostic Imaging Multiple Procedures

Universal Citation: 8 CA Code of Regs 9789.17.1

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) Specified diagnostic imaging procedures are designated in the "Diagnostic Imaging Service Subject to the Multiple Procedure Payment Reduction (MPPR)" file of the CMS Physician Fee Schedule final rule, and in the CMS National Physician Fee Schedule Relative Value excel file, to indicate that the Multiple Procedure Payment Reduction (MPPR) shall be applied to the professional component (PC) and technical component (TC) of the procedure, when multiple services are furnished to the same patient, in the same session, on the same day, by one or more physicians in the same group practice. The MPPR shall apply to both PC-only services, TC-only services, and to the PC and TC of global services. If the procedure is reported in the same session, on the same day, and furnished to the same patient, by one or more physicians in the same group practice (same Group National Provider Identifier (NPI)), the maximum reimbursement shall be determined as follows:

(1) Full payment is made for each PC and TC with the highest payment under the physician fee schedule.

(2)
(A) For services rendered prior to March 1, 2017 payment is made at 75 percent for subsequent PC services furnished to the same patient, in the same session, on the same day, by one or more physicians in the same group practice (NPI).

(B) For services rendered on or after March 1, 2017, payment is made at 95 percent for subsequent PC services furnished to the same patient, in the same session, on the same day, by one or more physicians in the same group practice (NPI).

(3) Payment is made at 50 percent for subsequent TC services furnished to the same patient, in the same session, on the same day, by one or more physicians in the same group practice (NPI).

(4) The individual PC and TC services with the highest payments under the physician fee schedule of globally billed services must be determined in order to calculate the MPPR.

(b) See section 9789.19 for the diagnostic imaging procedures subject to the radiology diagnostic imaging multiple procedures discount, description of the diagnostic imaging family indicators, and diagnostic imaging family indicators for procedure, by date of service.

1. New section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 39).
2. Amendment of subsection (a) filed 3-23-2016; operative 1-1-2016 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2016, No. 13).
3. Redesignation and amendment of subsection (a)(2) as new subsection (a)(2)(A) and new subsection (a)(2)(B) filed 7-18-2017; operative 3-1-2017. Submitted to OAL as a file and print only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 29).

Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code

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