Multiple Surgery Discounting

If the payer is linked to a contract and the CPT® code is enabled for multiple procedure discounting, then the allowed amount is reduced. The discount is calculated in conjunction with the sequence of CPT®4 codes and the corresponding modifier percentage on the fee schedule.

When you want to apply multiple surgery discounts on the allowed amount, the following can be used as reference:

• In the File Maintenance contract library, you set the following:
  • Facility and non-facility amounts for the CPT®4 codes in the Fee Schedule tab
  • Sequence indicator and modifier percentage in the Modifier Reimbursement tab
• In NextGen® Enterprise PM's Estimate Patient Cost window, submit the CPT®4 code for cost estimation.
• The system fetches the fee that is scheduled for the CPT®4 code.
• Based on the sequence that the CPT®4 code has been entered, the system fetches the modifier percentage.
• The allowed amount for the CPT®4 code is calculated as follows:
  • For the CPT®4 code with modifier assigned: [Allowed amount] = [Fee scheduled for the CPT®4 code] x [Multiple Proc %] x [Modifier %]
  • For the CPT®4 code without modifier assigned: [Allowed amount] = [Fee scheduled for the CPT®4 code] x [Multiple Proc %]