MPPR Soon To Increase

March 6, 2013
Rick Gawenda

On April 1, 2013, the multiple procedure payment reduction will increase to 50% in all outpatient therapy settings who are reimbursed under the Medicare Physician Fee Schedule. The first unit of the CPT code that has the highest practice expense (PE) value will retain 100% of its value. Subsequent units of that CPT and all other CPT codes billed that day will have their PE value decreased by 50%. This will cause an approximate 6-9% reduction in your payments.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. Rick,
    Hi 2 questions:
    1. Can you clarify the above increase.. Is it for Rehab Agencies or just hospital or private physical therapists? I am so surprised they are going from 90% to 50%… Also, does the current MPPR affect CPT codes even if there are no other disciplines seen on that same day.

    1. The MPPR discount is the same percentage for all outpatient settings. The MPPR applies whether 1 discipline is seeing the patient or all 3 are seeing the patient.

    1. Of course, the simple answer is yes, both SLP and OT can bill the same CPT code(s) on the same date of service. What an insurance carrier pays for is a different story. You would have to check with each insurance carrier as some may consider it duplicate therapy.