Billing for multiple same-day procedures (MSD)

Multiple same-day procedures are services performed by a physician:

  • During the same encounter
  • For the same patient
  • On the same date

Providers affected

This logic applies to claims submitted by facilities or professionals, in and out of network, for all Priority Health medical plans, including Medicaid and Medicare.

Guidelines

The multiple procedures modifier 51 is not required on claim lines when multiple procedures are performed on the same day. Priority Health will apply multiple same-day surgical logic based on our fee schedule amounts.

  • The service with the highest allowed fee amount will be priced at 100% of the Priority Health fee schedule.
  • Each additional same-day procedure (as defined above) will be priced at 50% of the fee (based on the lesser of billed charges or fee schedule amount.)
  • Services reported with modifiers such as 59, F1, F2, T1, T2, RT, LT, etc. will be subject to the multiple same-day procedures reduction.
  • This reduction will be identified as "MSD" on your remittance advice.

Exceptions

Add-on CPT codes and modifier 51-exempt codes within the surgical CPT range 10000- 69999 are not subject to the multiple same-day procedures reduction.

Last modified: 4/23/2014
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