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Special Alert March 2026 - Implementation of Multiple Surgery Reduction (MSR) Rules for Endoscopic Procedures Billed by Ambulatory Surgery Centers (ASCs)
Providence Health Plan·Gastroenterology, General Surgery·Provider News
Effective date
Mar 4, 2026
We identified it
Jul 2, 2026
Summary
Providence Health Plan is implementing Multiple Surgery Reduction (MSR) rules for endoscopic procedures billed by ASCs effective March 4, 2026. Endoscopies from the same family will follow CMS special rules (highest paid at 100%, subsequent paid at difference from base code), while unrelated endoscopies and non-endoscopic procedures will be paid at 50% MSR. This aligns ASC payments with national CMS policy and will result in reduced reimbursement for claims with multiple procedures.
Action Required
By March 4, 2026: Billing team must update billing system to apply MSR rules to all ASC-billed endoscopy claims. (1) Reprogram system to identify endoscopy procedure families and pay the highest-valued endoscopy at 100%, with subsequent same-family procedures paid at the difference between the procedure's allowed amount and base code's allowed amount. (2) Apply standard 50% MSR payment to unrelated endoscopies from different families. (3) For endoscopies combined with non-endoscopic procedures, apply special endoscopy rules to the endoscopy family and 50% MSR to non-endoscopic procedures. (4) Ensure system does NOT separately pay base codes when a higher-complexity endoscopy from the same family is billed. (5) Train billing staff on the new rules and audit claims processed on/after 3/4/2026 for compliance. Failure to implement these rules will result in incorrect claim payments and potential recovery demands from Providence Health Plan.