MO HealthNet Division (MHD) receives inquires regarding MHD policy for claim denials concerning multiple surgical procedures on the same patient on the same date of service. Please refer to Section 13.33.F of the Physician Provider Manual for additional information on billing for multiple surgical procedures.
When multiple surgical procedures are performed for the same body system through the same incision, the major procedure is considered for payment at 100% of the Medicaid allowable fee for the procedure (No reimbursement is made for incidental procedures).
Multiple surgical procedures performed on the same recipient, on the same date of service, by the same provider, for the same or separate body systems through separate incisions must be billed in accordance with the following guidelines:
- The major, secondary, and tertiary procedures should be indicated on the claim form using appropriate Current Procedural Terminology (CPT) codes.
- A copy of the Operative Report may be attached to claims for multiple surgeries to provide additional information. If not attached, a copy may be requested to assist with the claim processing.
Claims for multiple surgeries are allowed according to the following:
- 100% of the allowable fee for the major procedure.
- 50% of the allowable fee for the secondary procedure.
- 25% of the allowable fee for the tertiary procedure(s).