Multiple-procedure rule
The multiple-procedure rule reduces reimbursement for additional procedures performed by the same clinician on the same day or during the same session.
Updated
Under the multiple-procedure rule, the highest-valued procedure is paid at the full rate while subsequent procedures performed in the same session or on the same day are reimbursed at a reduced percentage.
The reduction reflects the efficiencies of performing multiple services together, such as shared preparation, anesthesia, and room time.
In practice
Billers sequence procedures with the primary (highest-value) procedure first so that payer systems apply the correct reduction to subsequent codes, ensuring expected reimbursement matches adjudication.
Commonly confused with
- National Correct Coding Initiative (NCCI): NCCI edits flag potentially incompatible or duplicative code combinations that should not be billed together; the multiple-procedure rule reduces payment for legitimately performed additional procedures.