Update to Multiple Procedure Payment Reduction reimbursement

IMMEDIATELY: Billing team must review and update all diagnostic imaging claim submission workflows in billing software. ACTION 1: Configure billing system to apply MPPR only to PROFESSIONAL claims for Commercial and Medicare Advantage plans; REMOVE Medicaid from MPPR application. ACTION 2: Ensure facility claims for diagnostic imaging are NOT subject to MPPR reduction—verify billing software does not apply reduction to facility/institutional billing. ACTION 3: Audit recent claims (last 30 days) submitted under the previous policy guidance that may have incorrectly applied MPPR to Medicaid or facility claims; identify and resubmit as needed or file appeals. ACTION 4: Providers and billing staff must reference the distinction between professional vs. facility claims when coding diagnostic imaging procedures. ACTION 5: Contact Provider Services at 1-866-918-1595 or your physician account executive immediately if your practice submitted Medicaid or facility claims with MPPR applied under the old guidance. DEADLINE: Complete system configuration before next claim submission cycle. Failure to implement this change will result in incorrect payment reductions on Medicaid claims and facility claims that should not have MPPR applied, or missed reductions on Commercial/Medicare Advantage professional claims.