CommercialReimbursementMedium impact
Update to Multiple Procedure Payment Reduction reimbursement
UPMC Health Plan·Diagnostic Imaging, Radiology·Reimbursement
We identified it
Jun 20, 2026
Summary
UPMC Health Plan modified their Multiple Procedure Payment Reduction (MPPR) policy for diagnostic imaging services. The policy now only applies to professional claims (not facility claims) and excludes Medicaid claims, affecting only Commercial and Medicare lines of business with percentage-based contracts.
Action Required
Immediately: Billing teams should verify current MPPR application settings for diagnostic imaging professional claims. Ensure MPPR reductions are NOT being applied to facility claims or Medicaid claims. Update billing system rules to apply MPPR only to professional diagnostic imaging claims for Commercial and Medicare patients with percentage-based contracts. Contact UPMC Provider Services at 1-866-918-1595 if clarification is needed on contract types.