What is the payment rate for the second highest value code under the multiple procedure rule?

The payment rate for the second highest value code under the multiple procedure rule is 50%. This guideline is part of the pricing strategies within the healthcare payment systems, particularly in outpatient settings. Under this rule, when multiple procedures are performed during the same session, the highest valued procedure receives full reimbursement. The second highest value procedure receives a reduced payment rate, which is set at 50% of its allowable payment. This tiered approach is designed to control costs and encourages the efficient use of healthcare resources by adjusting payments based on the number of services provided.

Understanding this rate is crucial for proper documentation and billing, as it directly impacts the reimbursement clinicians and facilities receive for the services they provide. Knowing these rates helps ensure that claims are submitted accurately and in compliance with regulations, avoiding underpayment or potential audits.