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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·OR · Gastroenterology, General Surgery·Provider News
Effective date
Mar 4, 2026
We identified it
Sep 2, 2026
Summary
Providence Health Plan is implementing CMS Multiple Surgery Reduction (MSR) rules for endoscopic procedures billed by Ambulatory Surgery Centers (ASCs) effective March 4, 2026. The highest-valued endoscopy will be paid at 100%, with subsequent endoscopies in the same family paid at a reduced rate (difference between procedure and base code), and unrelated procedures paid at 50%. ASCs should expect significantly reduced reimbursement on claims with multiple endoscopies or endoscopies combined with other surgical procedures.
Action Required
By March 4, 2026: Billing team must update billing software and claims adjudication logic to apply the new MSR rules for all ASC-billed endoscopic procedures. (1) For multiple endoscopies in the same family, configure system to pay the highest-valued procedure at 100% and subsequent procedures at the difference between the procedure's allowed amount and base code amount. (2) For endoscopies from different families, apply 50% reduction to secondary procedures. (3) For endoscopy combined with non-endoscopic procedures, apply special endoscopy rules to the endoscopy and 50% MSR to other procedures. (4) Configure system to prevent separate payment for base codes when a more complex endoscopy from the same family is performed. (5) Update claim submission templates and provider instructions to reflect new payment methodology. (6) Notify ASC providers in-network of the change and expected reimbursement impact. Failure to implement these changes will result in incorrect claim payments and potential overpayments subject to recoupment.