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.
