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MA00.057, Multiple Procedure Payment Reduction (MPPR) Guidelines for Transvaginal and Transabdominal Ultrasounds
Effective date
Mar 2, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage implemented a new Multiple Procedure Payment Reduction (MPPR) policy effective 03/02/2026 that reduces reimbursement to 50% for secondary transvaginal and transabdominal ultrasounds performed on the same date of service. The highest-allowance procedure receives 100% reimbursement; all subsequent procedures receive 50%. This applies to both obstetric and non-obstetric ultrasounds billed by the same provider or within the same facility on a single claim.
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What to do
Action · 6 steps
01By 03/02/2026: Billing team must update billing system to automatically apply 50% payment reduction to secondary transvaginal/transabdominal ultrasound codes (76817, 76830, 76801, 76805, 76811) when multiple codes are billed on the same date of service for the same member by the same provider.
02Configure system to identify the highest-allowance procedure code for 100% reimbursement and reduce all subsequent codes to 50% of contracted rate.
03Ensure claims are submitted on a single claim form for same-day multiple procedures.
04Update claim scrubbing logic to exclude add-on codes and Modifier 51 exempt codes from MPPR reduction.
05Train billing staff to verify medical necessity documentation is present in member records before claim submission.
06Implement audit process to review claims for compliance with MPPR hierarchy.
If missed: Failure to apply reductions may result in overpayment recovery by Independence Blue Cross.
Codes mentioned
7681776830768017680576811
Original notice
MA00.057, 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 & 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 & Billing00.01.72, 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