Multiple Surgeries on the Same Day


Avoid delays and denials by submitting procedures subject to multiple surgery payment rules on the same claim whenever possible.

How Is a Multiple Surgery Defined?
Multiple surgeries are separate procedures performed by a single physician or physicians in the same group practice on the same patient at the same operative session or on the same day for which separate payment may be allowed.

Steps to Determine Multiple Surgery Rules
Determine whether the procedure is subject to multiple surgery rules by accessing the
CMS Medicare Physician Fee Schedule Database on the CMS website. 

  • Key the CPT code and check the "multsurg" field
    • If that field indicates the surgical procedure is a 2, multiple surgery payment rules apply when performed on the same day as another procedure subject to multiple surgery payment rules
      • The procedure with the highest fee schedule is paid at 100 percent
      • Other procedures with indicator 2 are reduced by 50 percent
  • If the multsurg field for the surgical procedure indicates 3, special rules for multiple endoscopic procedures apply
    • These services should also be submitted on the same claim
  • If the second surgery on the same date is performed at a different time (e.g., due to complications that required a return trip to the operating room, or an unrelated surgical procedure), a modifier may be required
    • Refer to instructions in the Palmetto GBA Modifier Lookup Tool for instructions on submitting and documenting CPT modifiers 78 and 79
  • Some electronic billing software is set up to allow only six lines to be transmitted. Palmetto GBA can receive electronic claims with an unlimited number of lines. You may want to consider talking to your software vendor to increase the available number of lines per claim.
How Are Reductions in Payment Applied to the Services?
The reductions are applied regardless of whether the services are submitted on the same or separate claims. However, when services are submitted on separate claims, additional processing time is required and may delay payment or result in denial of the service(s).

Resource
  • Additional information regarding reimbursement calculations for multiple surgeries is available in the CMS Medicare Claims Processing Manual (PDF, 1.1 MB) (Pub. 100-04), Chapter 12, Section 40.6




Last Updated: 05/29/2020