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00.01.72, Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal Ultrasounds
Act
by Mar 2, 2026
Effective date
Mar 2, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross implemented a new Multiple Procedure Payment Reduction (MPPR) policy effective March 2, 2026, that reduces reimbursement to 50% for secondary transvaginal or transabdominal ultrasound procedures when both are performed on the same patient by the same provider on the same date of service. Only the highest-allowance procedure receives 100% reimbursement; all subsequent procedures receive 50% payment.
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What to do
by Mar 2, 2026 · 6 steps
01Billing team must implement MPPR logic in billing system to automatically apply 50% payment reduction to secondary transvaginal or transabdominal ultrasound codes when multiple codes are billed on the same date of service by the same provider.
02Update claim scrubbing rules to identify code pairs (76817/76830 with 76801/76805/76811) and apply hierarchy-based payment (highest allowance = 100%, subsequent = 50%).
03Providers must ensure medical records document medical necessity for both procedures to avoid claim denials.
04Train billing staff on new payment reduction rules and update superbill templates to alert providers when multiple ultrasound procedures are being ordered on the same date.
05Verify all claims for these five CPT codes are submitted on a single claim form per policy requirements.
06Non-compliance will result in underpayment or claim denials.
Codes mentioned
7681776830768017680576811
Original notice
00.01.72, Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal Ultrasounds
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA00.057, Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal UltrasoundsHighEffective Mar 2, 2026 · Claims & BillingMA00.057, Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal UltrasoundsHighEffective Mar 2, 2026 · Claims & Billing00.03.10f, Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductMediumEffective Sep 25, 2023 · Medical Policy00.01.72, Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal UltrasoundsMediumEffective Mar 2, 2026 · Claims & BillingBrowse every Independence Blue Cross change in the policy list