MULTIPLE OR BILATERAL PROCEDURES

As it relates to billing for both related, and unrelated multiple procedures, the same rationale for additional fees is also applicable to hospital outpatient and ambulatory surgical center facility fees but not applicable to inpatient care.

Multiple related procedures shall not warrant an additional fee except in those subsections of the listings where separate codes are given. When more than one identifiable surgical procedure or service is rendered, an additional fee may be warranted. Identify each procedure and bill at full value for the major procedure and at 50% for the lesser procedure, up to four (4) more additional / secondary procedures paid at 50% of the maximum allowable payment. Additional related procedures, beyond the total of five (5) as defined, may be considered for payment on an individual by report (BR) basis.

When multiple procedures, unrelated to the major procedure and adding significant time or complexity are provided at the same operative session, payment is for the procedure with the highest allowance, plus 50% for the lesser procedure, up to four (4) more additional / secondary procedures paid at 50% of the maximum allowable payment. 

When bilateral procedures are performed that require preparation of separate operative sites (e.g., bilateral carpal tunnel), payment for the second (or bilateral) procedure is to be reimbursed at 75% of the primary procedure. 

MULTIPLE/BILATERAL EXAMPLES 

Related Procedures. 

a) Open reduction of a fracture: the excision of a previous scar, the incision of fascia and muscle, the identification and retraction of nerves, muscles, and area structures, and the closure of the wound (irrespective of type of closure) are all related to the principal procedure of the bone repair and merit no additional fee. 

b) Repair of a tendon: the skin incision and linear closure, as well as the identification, incision and retraction of adjacent or overlying structures are related to the principal procedure and merit no additional fee.  

Unrelated Procedures.

 a) Multiple lacerations of an area such as the face: an additional fee may be warranted when such lacerations are not continuous. 

b) Closure of an incision or laceration incidental to the repair of deeper structures such as nerves, tendons, etc., does not merit an additional fee irrespective of the method of closure.