Special Alert March 2026 - Implementation of Multiple Surgery Reduction (MSR) Rules for Endoscopic Procedures Billed by Ambulatory Surgery Centers (ASCs)

Already effective as of March 4, 2026: Verify whether the practice's ASC billing workflows have implemented the MSR rules for endoscopic procedures and confirm current applicability with Providence Health Plan. Billing team should review all ASC-billed endoscopy claims processed on or after March 4, 2026 to ensure: (1) claims with multiple endoscopies in the same family apply the special endoscopy rule (highest at 100%, subsequent at difference amount); (2) endoscopies from different families apply CMS MSR (100% highest, 50% additional); (3) combined endoscopy/non-endoscopy procedures apply appropriate reduction rules per category. Update billing system logic and claim scrubbing protocols to prevent incorrect payment submissions. Train billing staff on the three payment rule categories to avoid claim denials and payment delays. Contact Providence Health Plan to clarify base code identification and allowable amount calculations if unclear on implementation.