Medicare payment for multiple surgical procedure - standard pricing method


Pricing Methods

According to Medicare guidelines, surgical procedures may be priced by two different pricing methods:

* Standard.
* Endoscopic.

Standard Pricing Method
The standard pricing method is denoted by an indicator of (2) under the “Mult Proc” column on the Medicare Physician Fee Schedule Database (MPFSDB). The allowance is calculated at:

* One hundred percent for the procedure with the highest fee schedule amount.
* Fifty percent for the second through fifth highest fee schedule amounts.

Each standard priced procedure after the fifth procedure requires submission of an operative report.
Standard Pricing Example

The following example demonstrates the standard pricing method:

Code Database Indicator Billed Amount $ Medicare Allowed Amount $ Ranking Allowance $
35301    2                             2,000             1,043.48                                   100%          1,043.48 x 80%
35201    2                           1,000                 922.90                                    50%            461.45 x 80%
35261    2                            1,050             1,010.60                                    50%           505.30 x 80%

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