BRS supports payment policies for Professional Services, including:
- Resource-Based Relative Value Scale (RBRVS) pricing for Medicare participating and non-participating professionals
- Geographic Practice Cost Index (GPCI) adjustment
- Place of Service (POS) pricing differential (non-facility and facility rates)
- National Correct Coding Initiative (NCCI) edits
- Medically Unlikely Edits (MUEs)
- Pricing by ZIP Code (nine digits, when required), or physician locality
- Locality-specific carrier-priced codes included
- Anesthesia pricing, including automatic conversion to anesthesia time units, special modifier pricing and locality-specific conversion factor
- Includes pricing under the Drugs and Biologicals fee schedule, Clinical Laboratory fee schedule, Durable Medical Equipment (DME) fee schedule and Parenteral and Enteral Nutrition (PEN) fee schedule
- Multiple Procedure Reductions (with and without modifier 51)
- E&M denial when billed in the same day as a significant procedure if not billed with modifier 25
- Lab panel pricing based on ATP rates
- OPPS cap to the technical component of certain imaging procedures
- Surgical modifier reductions
- Bilateral procedure logic (modifier 50)
- Surgical assistant reductions (modifiers 80, 81, 82, AS)
- Multiple endoscopy rules
- Multiple procedure reduction of the technical component (TC) of certain diagnostic imaging procedures and certain therapy codes
- “Lesser of” policy
- Discounted pricing for Physician Assistant and Nurse Midwife
- Health Professional Shortage Area (HPSA), HPSA Surgical Initiative Payment (HSIP) and Physician Scarcity Area (PSA) bonuses paid on a claim basis
- National Coverage Determinations (NCDs) for clinical laboratory codes