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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 new Multiple Procedure Payment Reduction (MPPR) guidelines effective March 2, 2026, that reduce reimbursement to 50% for secondary transvaginal and transabdominal ultrasounds performed on the same date of service. Billing teams must ensure both procedures are reported on a single claim and apply the hierarchy where the highest-allowance code is paid at 100% and subsequent codes at 50%. Add-on codes and Modifier 51 exempt codes are excluded from this reduction.
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What to do
by Mar 2, 2026 · 8 steps
01Billing team must update claims processing system to automatically apply MPPR guidelines when both transvaginal and transabdominal ultrasound codes are reported on the same date of service by the same provider.
02Identify the procedure code with the highest contracted allowance and reimburse at 100%.
03Reduce all subsequent ultrasound procedure codes to 50% of contracted rate.
04Ensure both procedures are bundled on a single claim form (CMS-1500 or 837p for professional providers, CMS-1450 or 837i for facility providers).
05Exclude add-on codes and Modifier 51 exempt codes from the reduction.
06Verify medical necessity documentation is present in the member's medical record before processing.
07Update billing software edits, create internal training for coders, and communicate changes to all providers.
08Claims submitted after March 2, 2026, with duplicate transvaginal/transabdominal ultrasounds that are not properly reduced will be reprocessed or denied, resulting in claim rework and potential payment delays.
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 UltrasoundsHighEffective Mar 2, 2026 · Claims & BillingBrowse every Independence Blue Cross change in the policy list