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 apply to critical access hospitals?
- How does the MPPR work and impact me?
- How does the MPPR policy impact the annual therapy therapy threshold dollar amount?
- To what CPT codes does the Multiple Procedure Payment Reduction policy apply to?
- How can I find the list of CPT codes that the Multiple Procedure Payment Reduction policy apply to?
- Can you give an example how the MPPR policy impacts my payment?
- If a Medicare beneficiary has speech therapy at one facility and physical or occupational therapy at a different facility (i.e. different group number or tax ID number), how does the Multiple Procedure Payment Reduction (MPPR) policy work?
- Does MPPR automatically apply to all Medicare Advantage plans?
Lets begin!
Question #1
What outpatient therapy settings does the MPPR policy apply to?
Answer
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Question #2
Does the MPPR policy apply to critical access hospitals?
Answer
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Question #3
How does the MPPR work and impact me?
Answer
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Question #4
How does the MPPR policy impact the annual therapy therapy threshold dollar amount?
Answer
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Question #5
To what CPT codes does the Multiple Procedure Payment Reduction policy apply to?
Answer
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Question #6
How can I find the list of CPT codes that the Multiple Procedure Payment Reduction policy apply to?
Answer
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Question #7
Can you give some examples how the MPPR policy impacts my payment?
Answer
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Question #8
If a Medicare beneficiary has speech therapy at one facility and physical or occupational therapy at a different facility (i.e. different group number or tax ID number), how does the MPPR policy work?
Answer
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Question #9
Does MPPR automatically apply to all Medicare Advantage plans?
Answer
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I hope you found this article helpful and that you now have a better understanding of MPPR. Thank you for being a Gold Member!
All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.
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.
Hi Rick. If the PTA payment differential kicks in next year, then would there a payment reduction for PTA’s PLUS MPPR as well? In other words, would the payment by a PTA be reduced two times?
That is correct.
Rick
Does West Region Tricare ( Health Net Federal Services) utilize MPPR?
You will be able to tell by reviewing your EOB’s and each line item.
Hi Rick,
I have looked up your examples on the physician fee schedule. What you are not providing is the equation of how a 50% reduction in PE RUV decreases the reimbursement rate. For example you stated in example 5: “2 units of CPT code 97530 were each reduced from $39.79 to $28.14”. When dividing the $28.14/$39.79 = 70.7% decrease in reimbursement. Obviously this is not the way to calculate a 50% decrease in PE RUV. So to me there is a missing step. You deal with PE RUV all the time and I am sure it is very simple, but I am just missing the step needed to take your example and apply it to any situation I am in with billing. Could you please fill in the gap? Thanks.
Please read my MPPR FAQs at https://gawendaseminars.com/faq/mppr/
Hi Rick, I read it. You have question seven word for word on their as well. I may have missed it but I don’t see where you show how to calculate the reduction in reimbursement based upon the 50% reduction in PE RUV. It just says that we should expect about a 20% overall reduction in payment (paraphrased). So I am back to the same question. How do you calculate reimbursement of a CPT code that has had its PE RUV reduced by 50%? Thanks
If the PE RVU for a CPT code is 0.44 and is being reduced by 50%, then the PE RVU for that CPT code becomes 0.22. This article and the MPPR FAQs is not teaching you then how to determine the payment amount for each CPT code. That is a whole different article and a more complicated formula that would need to be done by hand for every CPT code.