Customer detail

ARSA

38
live contracts
9
cannot fire
16
calc types
1
SQL bodies
0
of those blocked
0
map conflicts

Methodology mix

ModifierAdjustment296
PercentOfFees43
FlatPercentOfCharges42
MedicareMultipleProcedureAdjustment41
LesserOfAdjustment41
MedicareBilateralSurgeryAdjustment41
MedicareMultipleRadiologyAdjustment41
MedicareMultipleTherapyAdjustment41
MidLevelProviderAdjustment22
MedicareDrug19
MedicareLab19
MedicareRVU19
MedicareDME19
SqlExpression2
MedicareASC2
NotToExceedAmountAdjustment1

Contracts

Each is one fee logic. Base terms are first-match-wins; adjustments all apply, in order. Expand to see the terms.

CRBS-Aetna-Commercial-Profee8 base · 13 adj
Aetna
Profee · CRBS · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the CRBS-Aetna-Comm-Carveout-Profee fee schedule
  2. 100% of Medicare lab
  3. 100% of Medicare drug
  4. 100% of Medicare DME
  5. 100% of Medicare RVU
  6. 100% of the CRBS-Aetna-Comm-NonFacility-Profee fee schedule — when FacilityType in Clinic
  7. 100% of the CRBS-Aetna-Comm-Facility-Profee fee schedule — when FacilityType in ASC, Home, Hospital
  8. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
CRBS-Aetna-Medicare-Profee5 base · 5 adj
Aetna Medicare
Profee · CRBS · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare lab
  2. 100% of Medicare drug
  3. 100% of Medicare DME
  4. 100% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. cap each charge and the account total at 100% of billed charges
CRBS-Cigna-Commercial-Profee2 base · 13 adj
Cigna
Profee · CRBS · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 75% of billed charges — when CodeRange in S2066–S2068
  2. 60% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
ChargeMaster-CRBS 1 base · 0 adj
Charges
Profee · CRBS · 2025-10-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the CRBS-ChargeMaster fee schedule
ChargeMaster-Facility TWOR/TPSC 1 base · 0 adj
Charges
Facility · TPSC, TWOR · 2025-02-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the TWOR-ChargeMaster fee schedule
ChargeMaster-MHS1 base · 0 adj
Charges
Profee · MHS · 2025-10-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-ChargeMaster fee schedule
ChargeMaster-MWB2 base · 0 adj
Charges
Profee · MWB · 2025-10-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-Kocak-ChargeMaster fee schedule — when Provider 40 is present
  2. 100% of the MWB-ChargeMaster fee schedule
ChargeMaster-TPSC1 base · 0 adj
Charges
Profee · PSN, TPSC, TWOR · 2025-02-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the TPSC-ChargeMaster fee schedule
MHS-Aetna-Commercial-Profee4 base · 14 adj
Aetna
Profee · MHS · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-Aetna-Commercial-Profee-Carveout fee schedule
  2. 100% of the MHS-AetnaMarketFS-Facility-Profee fee schedule — when FacilityType in ASC, Home, Hospital
  3. 100% of the MHS-AetnaMarketFS-NonFacility-Profee fee schedule
  4. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
MHS-Aetna-Medicare-Profee3 base · 14 adj
Aetna Medicare
Profee · MHS · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-AetnaMarketFS-Facility-Profee fee schedule — when FacilityType in ASC, Home, Hospital
  2. 100% of the MHS-AetnaMarketFS-NonFacility-Profee fee schedule
  3. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
MHS-BCBS-Commercial-Profee2 base · 14 adj
BCBS - TX, BCBS PPO - TX
Profee · MHS · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-BCBS-Commercial-Profee fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
MHS-BCBS-HMO-Profee2 base · 14 adj
BCBS HMO - TX
Profee · MHS · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-BCBS-HMO-Profee fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
MHS-CommunityHealthChoiceMedicare-Marketplace-Profee6 base · 13 adj
Community Health Choice
Profee · MHS · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 30% of billed charges — when CodeRange in S2066–S9068
  2. 100% of Medicare lab
  3. 100% of Medicare drug
  4. 100% of Medicare DME
  5. 100% of Medicare RVU
  6. 30% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-Aetna-Commercial-Profee6 base · 5 adj
Aetna
Profee · MWB · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-Aetna-Comm-Carveout-Profee fee schedule
  2. 115% of Medicare lab (rates as of 2013-01-01)
  3. 115% of Medicare drug (rates as of 2013-01-01)
  4. 115% of Medicare DME (rates as of 2013-01-01)
  5. 115% of Medicare RVU (rates as of 2013-01-01)
  6. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. cap each charge and the account total at 100% of billed charges
MWB-Aetna-Medicare-Profee5 base · 5 adj
Aetna Medicare
Profee · MWB · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare lab
  2. 100% of Medicare drug
  3. 100% of Medicare DME
  4. 100% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. cap each charge and the account total at 100% of billed charges
MWB-AnthemBCBS-Commercial-Profee2 base · 13 adj
Anthem_OH, BCBS - OH
Profee · MWB · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-AnthemBCBS-Comm-Carveout-Profee fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-AnthemBCBS-Medicare-Profee2 base · 13 adj
Anthem Medicare_OH, BCBS Medicare - OH
Profee · MWB · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-AnthemBCBS-Comm-Carveout-Profee fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-Humana-Commercial-Profee7 base · 14 adj
Humana
Profee · MWB · 2026-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-Humana-Comm-Carveout-Profee fee schedule
  2. 100% of Medicare lab
  3. 100% of Medicare drug
  4. 100% of Medicare DME
  5. 100% of Medicare RVU
  6. 100% of the MWB-Humana-005452FS-NonFacility-Profee fee schedule — when FacilityType in Clinic
  7. 100% of the MWB-Humana-005452FS-Facility-Profee fee schedule — when FacilityType in ASC, Home, Hospital, Hospital/ASC
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
MWB-Humana-Medicare-Profee3 base · 14 adj
Humana Medicare
Profee · MWB · 2026-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-Humana-005452FS-NonFacility-Profee fee schedule — when FacilityType in Clinic
  2. 100% of the MWB-Humana-005452FS-Facility-Profee fee schedule — when FacilityType in ASC, Home, Hospital, Hospital/ASC
  3. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
Medicare-ASC2 base · 13 adj
Medicare
Facility · all facilities · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare ASC
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 82 present → 16% of the running amount
  11. modifier AS present → 13.6% of the running amount
  12. mid-level provider reduction (by NUCC taxonomy)
  13. cap each charge and the account total at 100% of billed charges
Medicare-Profee5 base · 14 adj
Medicare
Profee · all facilities · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare lab
  2. 100% of Medicare drug
  3. 100% of Medicare DME
  4. 100% of Medicare RVU
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
PSN-Aetna-Commercial-Profee3 base · 14 adj
Aetna
Profee · PSN · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the PSN-Aetna-Comm-Facility-Profee fee schedule — when FacilityType in ASC, Home, Hospital, Hospital/ASC
  2. 100% of the PSN-Aetna-Comm-NonFacility-Profee fee schedule
  3. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
PSN-UHC-Commercial-Profee5 base · 14 adj
UHC
Profee · PSN · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 85% of Medicare lab (rates as of 2020-01-01)
  2. 85% of Medicare drug (rates as of 2020-01-01)
  3. 60% of Medicare DME (rates as of 2020-01-01)
  4. 85% of Medicare RVU (rates as of 2020-01-01)
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
SCSH-Cigna-Commercial-Facility1 base · 14 adj
Cigna
Facility · SCSH · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 45.8% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap the account at $95000.00
  14. cap each charge and the account total at 100% of billed charges
Self-Pay-ASC2 base · 13 adj
Self-Pay
Facility · TWOR · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 450% of Medicare ASC
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 82 present → 16% of the running amount
  11. modifier AS present → 13.6% of the running amount
  12. mid-level provider reduction (by NUCC taxonomy)
  13. cap each charge and the account total at 100% of billed charges
Self-Pay-Profee6 base · 14 adj
Self-Pay, Self-Pay
Profee · PSN, TWOR · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 450% of Medicare lab
  2. 450% of Medicare drug
  3. 450% of Medicare DME
  4. 450% of Medicare RVU
  5. 100% of the TPSC-Custom-Codes fee schedule
  6. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
Self-Pay-Profee-TPSC6 base · 0 adj
Self-Pay, Self-Pay
Profee · TPSC · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 450% of Medicare lab
  2. 450% of Medicare drug
  3. 450% of Medicare DME
  4. 450% of Medicare RVU
  5. 100% of the TPSC-Custom-Codes fee schedule
  6. 0% of billed charges
TPSC-Cigna-Comm-Profee3 base · 14 adj
Cigna
Profee · PSN, TPSC, TWOR · 2025-11-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the TPSC-Cigna-Comm-NonFacility-Profee fee schedule — when FacilityType in Clinic
  2. 100% of the TPSC-Cigna-Comm-Facility-Profee fee schedule
  3. 50% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  3. Medicare bilateral-surgery adjustment
  4. Medicare multiple-procedure reduction — base codes 2
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 81 present → 16% of the running amount
  12. modifier 82 present → 16% of the running amount
  13. modifier AS present → 13.6% of the running amount
  14. cap each charge and the account total at 100% of billed charges
TPSC-Horizon-Medicaid-Profee5 base · 14 adj
Horizon Medicaid
Profee · PSN, TPSC, TWOR · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. 300% of Medicare DME (NJ)
  2. 106% of Medicare drug
  3. 300% of Medicare lab (NJ)
  4. 300% of Medicare RVU
    • CodeRange 99202–99498 → 150%
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 81 present → 16% of the running amount
  12. modifier 82 present → 16% of the running amount
  13. modifier AS present → 13.6% of the running amount
  14. cap each charge and the account total at 100% of billed charges
TPSC-HorizonBCBS-Comm-Profee4 base · 14 adj
Horizon BCBS
Profee · PSN, TPSC, TWOR · 2025-02-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the TPSC-HorizonBCBS-Comm-Carveout-Profee fee schedule
  2. 100% of the TPSC-HorizonBCBS-Comm-NonFacility-Profee fee schedule — when FacilityType in Clinic
  3. 100% of the TPSC-HorizonBCBS-Comm-Facility-Profee fee schedule
  4. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 81 present → 16% of the running amount
  10. modifier 82 present → 16% of the running amount
  11. modifier AS present → 13.6% of the running amount
  12. modifier 78 present → 70% of the running amount
  13. modifier 80 present → 16% of the running amount
  14. cap each charge and the account total at 100% of billed charges
TPSC-HorizonBCBS-Medicare-Profee5 base · 14 adj
Horizon BCBS Medicare
Profee · PSN, TPSC, TWOR · 2025-02-01 → 2999-12-31
Base terms — first match wins
  1. 100% of Medicare DME (NJ, rates as of 2020-01-01)
  2. 100% of Medicare drug (rates as of 2020-01-01)
  3. 100% of Medicare lab (NJ, rates as of 2020-01-01)
  4. 100% of Medicare RVU (rates as of 2020-01-01)
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. mid-level provider reduction (by NUCC taxonomy)
  14. cap each charge and the account total at 100% of billed charges
TWOR-Cigna-Comm-ASC2 base · 13 adj
Cigna
Facility · TWOR · 2025-12-15 → 2999-12-31
Base terms — first match wins
  1. 100% of the TWOR-Cigna-Comm-ASC-Fees fee schedule
  2. 50% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
TWOR-HorizonBCBS-Comm-ASC2 base · 13 adj
Horizon BCBS
Facility · TWOR · 2027-02-01 → 2999-12-31
Base terms — first match wins
  1. 239% of the TWOR-HorizonBCBS-FeeSchedule-ASC fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
TWOR-HorizonBCBS-Comm-ASC2 base · 13 adj
Horizon BCBS
Facility · TWOR · 2026-02-01 → 2027-01-31
Base terms — first match wins
  1. 232% of the TWOR-HorizonBCBS-FeeSchedule-ASC fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
TWOR-HorizonBCBS-Comm-ASC2 base · 13 adj
Horizon BCBS
Facility · TWOR · 2025-02-01 → 2026-01-31
Base terms — first match wins
  1. 225% of the TWOR-HorizonBCBS-FeeSchedule-ASC fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
TWOR-HorizonBCBS-Medicaid-ASC2 base · 13 adj
Horizon Medicaid
Facility · TWOR · 2025-12-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the TWOR-Horizon-Medicaid-ASC-Fees fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
TWOR-HorizonBCBS-Medicare-ASC2 base · 13 adj
Horizon BCBS Medicare
Facility · TWOR · 2025-02-01 → 2999-12-31
Base terms — first match wins
  1. 89.56% of the TWOR-HorizonBCBS-FeeSchedule-ASC fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare bilateral-surgery adjustment
  2. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  3. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  4. Medicare multiple-radiology reduction — base codes 4
  5. mid-level provider reduction (by NUCC taxonomy)
  6. modifier 22 present → 135% of the running amount
  7. modifier 54 present → 80% of the running amount
  8. modifier 62 present → 62.5% of the running amount
  9. modifier 78 present → 70% of the running amount
  10. modifier 80 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
TX-Medicaid-Profee1 base · 13 adj
Medicaid
Profee · all facilities · 2025-01-01 → 2999-12-31
Base terms — first match wins
  1. custom SQL — Nothing — the SQL body is only the standard input/output comment scaffold with no executable statement, so this SqlExpression always yields an empty/null result.
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges

Cannot fire (9)

These have no contract map, or one whose insurance / bill-type / facility selection is empty, so nothing can ever resolve to them.

MHS-CommunityHealthChoice-Medicaid-Profee · contract map selects nothing1 base · 13 adj
— no insurance selected —
— no bill type selected — · — nothing selected — · 2026-07-20 → 2999-12-31
Base terms — first match wins
  1. custom SQL — Nothing — the SQL body is only the standard input/output comment scaffold with no executable statement, so this SqlExpression always yields an empty/null result.
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MHS-MHHN-Exchange-Profee · contract map selects nothing6 base · 13 adj
MHHN
Profee · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-MHHN-Carveout-Profee-Fees fee schedule
  2. 115% of Medicare lab
  3. 115% of Medicare drug
  4. 115% of Medicare DME
  5. 115% of Medicare RVU
  6. 50% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MHS-MHHN-Medicare-Profee · contract map selects nothing6 base · 13 adj
MHHN Medicare
Profee · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MHS-MHHN-Carveout-Profee-Fees fee schedule
  2. 105% of Medicare lab
  3. 105% of Medicare drug
  4. 105% of Medicare DME
  5. 105% of Medicare RVU
  6. 50% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-Cigna-Commercial-Profee · contract map selects nothing6 base · 13 adj
Cigna
Profee · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-Cigna-Carveout-Profee-Fees fee schedule
  2. 100% of Medicare lab
  3. 100% of Medicare drug
  4. 100% of Medicare DME
  5. 100% of Medicare RVU
  6. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-MMO-Commercial-Profee · contract map selects nothing5 base · 13 adj
MMO
Profee · — nothing selected — · 2026-12-01 → 2027-11-30
Base terms — first match wins
  1. 155% of Medicare lab
  2. 155% of Medicare drug
  3. 155% of Medicare DME
  4. 155% of Medicare RVU
    • CodeRange 99202–99215 → 115%
    • CodeRange 99221–99239 → 115%
    • CodeRange 99381–99429 → 115%
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-MMO-Commercial-Profee · contract map selects nothing5 base · 13 adj
MMO
Profee · — nothing selected — · 2027-12-01 → 2999-12-31
Base terms — first match wins
  1. 160% of Medicare lab
  2. 160% of Medicare drug
  3. 160% of Medicare DME
  4. 160% of Medicare RVU
    • CodeRange 99202–99215 → 115%
    • CodeRange 99221–99239 → 115%
    • CodeRange 99381–99429 → 115%
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-MMO-Commercial-Profee · contract map selects nothing5 base · 13 adj
MMO
Profee · — nothing selected — · 2025-12-01 → 2026-11-30
Base terms — first match wins
  1. 150% of Medicare lab
  2. 150% of Medicare drug
  3. 150% of Medicare DME
  4. 150% of Medicare RVU
    • CodeRange 99202–99215 → 115%
    • CodeRange 99221–99239 → 115%
    • CodeRange 99381–99429 → 115%
  5. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-OhioHealth-Profee · contract map selects nothing6 base · 13 adj
Ohio Health
Profee · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 70% of billed charges — when CodeRange in S2066–S2068
  2. 165% of Medicare lab
  3. 165% of Medicare drug
  4. 165% of Medicare DME
  5. 165% of Medicare RVU
  6. 70% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges
MWB-Paramount-Commercial-Profee · contract map selects nothing2 base · 13 adj
Paramount
Profee · — nothing selected — · 2024-01-01 → 2999-12-31
Base terms — first match wins
  1. 100% of the MWB-Paramount-Comm-Carveout-Profee fee schedule
  2. 0% of billed charges
Adjustments — all apply, in order
  1. Medicare multiple-radiology reduction — base codes 4
  2. Medicare bilateral-surgery adjustment
  3. Medicare multiple-procedure reduction — base codes 2, 3; pays 100/50/50/50/50/50%
  4. Medicare multiple-therapy reduction (MPPR) — base codes 5; pays 100/50%
  5. modifier 22 present → 135% of the running amount
  6. modifier 54 present → 80% of the running amount
  7. modifier 62 present → 62.5% of the running amount
  8. modifier 78 present → 70% of the running amount
  9. modifier 80 present → 16% of the running amount
  10. modifier 81 present → 16% of the running amount
  11. modifier 82 present → 16% of the running amount
  12. modifier AS present → 13.6% of the running amount
  13. cap each charge and the account total at 100% of billed charges