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11/01/21

Understanding Medicare’s Multiple Procedure Payment Reduction Policy

On January 1, 2011, the Centers for Medicare and Medicaid Services implemented the multiple procedure payment reduction (MPPR) policy to outpatient physical, occupational and speech therapy services as well as other ancillary services. The purpose of MPPR is to reduce Medicare’s cost for these services. Even though MPPR has been around for 10 years, many therapists, office managers, billers, billing companies, practice owners, and financial analysts do not understand MPPR as it applies to outpatient therapy services. In this article, I will answer the following questions: What outpatient therapy settings does the MPPR policy apply to? Does the MPPR policy

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05/11/21

Palmetto Did Not Apply MPPR on All Therapy Claims

Palmetto GBA has announced that some skilled nursing facility (SNF) type of bills (TOB) 22X and 23X and Critical Access Hospital (CAH) TOB 85x with dates of service January 1 through April 11, 2021, processed prior to April 12, 2021, did not have the Multiple Procedure Payment Reduction (MPPR) applied on them. The system was updated on April 12, 2021, when the fix was installed. These TOBs with Revenue Code 042X, 043X or 044X present with more than 1 units or Revenue Code 042X, 043X or 044X present on more than one line with the same line item date of service, are

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02/09/20

UnitedHealthcare Updates Multiple Therapy Procedure Therapy Reduction Policy

UnitedHealthcare (UHC) has updated their Multiple Therapy Procedure Therapy Reduction policy for physical, occupational and speech-language pathology therapy services provided in the private practice setting. To access the revised policy, click HERE. This policy applies to UHC Commercial Plans. I hope you enjoyed this free article.

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11/25/19

2020 Annual Update to the Therapy Code List

The Centers for Medicare and Medicaid Services (CMS) has released the annual update that provides the list of codes that sometimes or always describe therapy services. Providers of therapy services need to be aware of this list and the annual updates as this list will tell providers which CPT codes the Multiple Procedure Payment Reduction (MPPR) policy does and does not apply to. Question Which CPT codes does the MPPR policy apply to? Answer Question Which CPT codes does the MPPR policy not apply to? Answer Question What’s the difference between an “always therapy” and “sometimes therapy” CPT code? Answer

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