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MA00.057, 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 Medicare Advantage has implemented a new Multiple Procedure Payment Reduction (MPPR) policy effective March 2, 2026, requiring that when both transvaginal and transabdominal ultrasounds are performed on the same patient on the same date of service, the highest-allowance procedure is reimbursed at 100% and all subsequent procedures at 50% of contracted rates. Billing teams must ensure these procedures are reported on a single claim and apply the 50% reduction to secondary ultrasound codes.
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What to do
by Mar 2, 2026 · 4 steps
01Billing team must update claims processing system to automatically apply MPPR payment reduction (100% for highest allowance code, 50% for subsequent codes) when both transvaginal (CPT 76817, 76830) and transabdominal (CPT 76801, 76805, 76811) ultrasounds are billed together for the same member on the same date of service.
02Ensure all ultrasound claims from the same provider or provider group on the same date of service are submitted on a single claim form per policy requirements.
03Providers must document medical necessity in patient records; failure to provide documentation upon request will result in service denials.
04Update billing software to prevent payment at 100% for both procedure codes and to exclude add-on codes and Modifier 51 exempt codes from MPPR reduction application.
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