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§ 9789.15.5 Ophthalmology Multiple Procedure Reduction

Summary

Under certain circumstances, the Physician Fee Schedule reduces reimbursement when Multiple Procedures are provided on the same day. These reductions are known as MPPRs.

Per section 9789.15.5, the MPPR on ophthalmology procedures only applies when multiple services are performed on the same day.

The MPPR only applies to:

  • technical component (TC) services, and
  • the TC of global services.

The MPPR does NOT apply to Professional Component services.

When the Ophthalmology MPPR is applied:

  • Full payment is made for the TC service with the highest payment.
  • Payment is made at 80% for subsequent TC services furnished by the same physician on the same day.

California Code of Regulations (CCR)

§ 9789.15.5 Ophthalmology Multiple Procedure Reduction

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

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