Multiple Procedures Payment Reduction for Medical and Surgical Services

Policy ID: Adm 164

Effective Date: January 01, 2027

Last Reviewed: July 06, 2026

Applies To: Migrated Commercial

This policy addresses reimbursement for multiple surgeries and multiple endoscopy procedures performed as outlined below.

Definitions

Code/Term

Code Description/Term Definition

Multiple Surgeries

Separate procedures performed by the same physician on the same patient at the same operative session or on the same day. Multiple surgeries are distinguished from procedures that are components of or incidental to a primary procedure. Intraoperative services, incidental surgeries, or components of more major surgeries may not be billed separately.

Multiple endoscopic procedures

Endoscopies performed on the same patient on the same day during the same session have special reimbursement rules applied by The Centers for Medicare & Medicaid Services (CMS). BCBSND applies the same payment methodology for endoscopic procedures.

Endoscopic Base Procedure Code

Located on the CMS National Physician Fee Schedule (PFS) Relative Value Unit (RVU) File in the endoscopic base code field.

Endoscopic Family

All endoscopy codes that have the same endoscopic base procedure code.

Bilateral surgeries

Procedures performed on both sides of the body at the same operative session or on the same day.

Policy Statement

Multiple Surgery Policy

Procedures subject to the multiple procedure reduction can be identified with an indicator of ‘1’, ‘2’, or ‘3’ in the Multiple Procedure field on the CMS PFS RVU File. Multiple procedures and/or bilateral procedures (Modifier 50) performed during the same operative session by the same physician or associate are reimbursed:

100% allowable for highest paying surgical procedure
50% allowable for all additional surgical procedures

Multiple Endoscopies Policy

Endoscopies subject to the multiple endoscopy reduction can be identified with an indicator of ‘3’ in the Multiple Procedure field on the CMS PFS RVU File. The reduction occurs when an endoscopic procedure is billed with another endoscopic procedure in the same base endoscopy family.

Multiple endoscopy pricing rules will be applied to each base endoscopy family before ranking procedures performed on the same day, such as non-endoscopic procedures. When an endoscopic procedure is reported with only its base procedure code, no separate payment will be made for the base code. Payment for the base code is included in the payment for the other endoscopy. Additionally, when an endoscopic procedure is billed with procedures that are not endoscopies (i.e., surgical procedures), the Multiple Surgery Policy applies. After the multiple endoscopic reduction is ranked additional reimbursement policies will be ranked based on the service provided, for example Bilateral Procedures or Multiple Surgery Policy, etc.

Reimbursement Examples

Multiple Related Endoscopies (Same endoscopic base procedure)

Determine the endoscopic procedure with the highest allowable rate and allow at 100%
For each additional endoscopy within the family, allow the difference between the endoscopic base code’s allowed rate and the additional endoscopy code’s allowed rate

Two endoscopic procedures (Different endoscopic base procedures)

In this scenario the Multiple Surgery Policy applies, and the multiple endoscopic reduction does not

Four Endoscopies (Two different endoscopic base procedures)

Follow the above calculation for determining each endoscopic family’s allowable amount
Compare the total allowance for each endoscopic family
The endoscopic family with the highest allowable amount will be allowable at 100%
The remaining endoscopic family will be allowed at 50%

Bilateral, Multiple Endoscopy and Multiple Surgery can apply on the same line of a claim

Bilateral calculation applies first
Multiple endoscopy calculation applies next
Multiple surgery calculation applies last

Note: BCBSND updates codes quarterly when made available by CMS and the American Medical Association (AMA). The official update of the Healthcare Common Procedure Coding System (HCPCS) for public use is located at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update

The official update of the AMA is located at https://www.ama-assn.org/.

References

Cross References

None

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.

History

Date

Updates

9/15/2020

Removed information about independent procedures as this is covered as part of National Correct Coding Initiative (NCCI) Editing Additional information about NCCI editing can be found in Correct Coding Guidelines.

10/26/2020

Combined Multiple Surgery and Multiple Endoscopy into one policy. Added reference to the order calculations are applied when more than one reduction applies to the same line on a claim.

4/25/2021

Added a note that codes are updated quarterly.

4/29/2022

Updated formatting and removed statement under Multiple Surgery policy that this policy may not apply to facility charges as multiple surgery reductions do apply to facility charges.

8/23/2023

Policy annual review completed

9/15/2024

Added more documentation regarding RVU indicators that apply Multiple Procedure Reductions. Added policy application date of service language. Removed Exclusions and Additional information under Multiple Surgery.

9/1/2025

Policy annual review completed.

7/6/2026

Created Migrated policy

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